Provider Demographics
NPI:1346693595
Name:COLETTA-GUADAGNO, MICHELLE (CERTIFIED TEACHER)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:COLETTA-GUADAGNO
Suffix:
Gender:F
Credentials:CERTIFIED TEACHER
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:COLETTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CERTIFIED TEACHER
Mailing Address - Street 1:400 OCEANSIDE PKWY
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572
Mailing Address - Country:US
Mailing Address - Phone:516-395-8569
Mailing Address - Fax:516-665-8142
Practice Address - Street 1:400 OCEANSIDE PKWY
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572
Practice Address - Country:US
Practice Address - Phone:516-395-8569
Practice Address - Fax:516-665-8142
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1203108171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator