Provider Demographics
NPI:1033747902
Name:DENADEL, MICHELLE ANTELO (MD)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:ANTELO
Last Name:DENADEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:MICHELLE
Other - Middle Name:NICOLE
Other - Last Name:DOMINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1959 NE PACIFIC STREET
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195
Mailing Address - Country:US
Mailing Address - Phone:206-744-2250
Mailing Address - Fax:206-744-6312
Practice Address - Street 1:1959 NE PACIFIC STREET
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195
Practice Address - Country:US
Practice Address - Phone:206-744-2250
Practice Address - Fax:206-744-6312
Is Sole Proprietor?:No
Enumeration Date:2020-03-27
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program