Provider Demographics
NPI:1144574823
Name:RIDDELL, MICHELE M (MSSPED)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:M
Last Name:RIDDELL
Suffix:
Gender:F
Credentials:MSSPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CORPORATE DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CENTRAL VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10917-4006
Mailing Address - Country:US
Mailing Address - Phone:845-255-5482
Mailing Address - Fax:845-255-5482
Practice Address - Street 1:2 CORPORATE DR
Practice Address - Street 2:SUITE 203
Practice Address - City:CENTRAL VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10917-4006
Practice Address - Country:US
Practice Address - Phone:845-255-5482
Practice Address - Fax:845-255-5482
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist