Provider Demographics
NPI:1417472440
Name:ABBATIELLO, MICHELLE (NP-C)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:ABBATIELLO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-1752
Mailing Address - Country:US
Mailing Address - Phone:516-384-3585
Mailing Address - Fax:
Practice Address - Street 1:2001 MARCUS AVE STE N220
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1049
Practice Address - Country:US
Practice Address - Phone:516-482-0910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-10
Last Update Date:2018-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF341892-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily