Provider Demographics
NPI:1073877502
Name:CENATIEMPO, MICHELLE ANN (MSED)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANN
Last Name:CENATIEMPO
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:MRS
Other - First Name:MICHELLE
Other - Middle Name:ANN
Other - Last Name:COLALELLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSED
Mailing Address - Street 1:733 HORATIO AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-3245
Mailing Address - Country:US
Mailing Address - Phone:516-481-2140
Mailing Address - Fax:
Practice Address - Street 1:733 HORATIO AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN SQUARE
Practice Address - State:NY
Practice Address - Zip Code:11010-3245
Practice Address - Country:US
Practice Address - Phone:516-481-2140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
NY783306174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist