Provider Demographics
NPI:1033296462
Name:MACHESKY, MICHELLE L (PA)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:L
Last Name:MACHESKY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 SAN REMO DR.
Mailing Address - Street 2:UVM MEDICAL CENTER
Mailing Address - City:S. BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6378
Mailing Address - Country:US
Mailing Address - Phone:802-862-3983
Mailing Address - Fax:802-863-7994
Practice Address - Street 1:6 SAN REMO DR.
Practice Address - Street 2:UVM MEDICAL CENTER
Practice Address - City:S. BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6378
Practice Address - Country:US
Practice Address - Phone:802-862-3983
Practice Address - Fax:802-863-7994
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0550030762363A00000X
VT055-0030975363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT796088OtherMVP
VT9000274Medicaid
VT8000474OtherLADIES FIRST
VT00069178OtherBLUE SHIELD