Provider Demographics
NPI:1144209388
Name:DISCHIAVO, MICHELE CONTE (PA)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:CONTE
Last Name:DISCHIAVO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:MICHELE
Other - Middle Name:LYNN
Other - Last Name:CONTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:116 BUSINESS PARK DR
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-6313
Mailing Address - Country:US
Mailing Address - Phone:315-624-7000
Mailing Address - Fax:315-793-1129
Practice Address - Street 1:116 BUSINESS PARK DR
Practice Address - Street 2:1ST FLOOR
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-6313
Practice Address - Country:US
Practice Address - Phone:315-624-7000
Practice Address - Fax:315-793-1129
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007840363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant