Provider Demographics
NPI:1093112211
Name:CARDAMONE, MICHELLE (RN)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:CARDAMONE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 RAIDER LN
Mailing Address - Street 2:
Mailing Address - City:HORSEHEADS
Mailing Address - State:NY
Mailing Address - Zip Code:14845-2344
Mailing Address - Country:US
Mailing Address - Phone:607-739-5601
Mailing Address - Fax:607-738-2445
Practice Address - Street 1:1 RAIDER LN
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-2344
Practice Address - Country:US
Practice Address - Phone:607-739-5601
Practice Address - Fax:607-738-2445
Is Sole Proprietor?:No
Enumeration Date:2014-12-03
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8256508163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY166002681Medicaid