Provider Demographics
NPI:1467114603
Name:KUDA, MICHELLE (CSCS)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:KUDA
Suffix:
Gender:F
Credentials:CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02813-3143
Mailing Address - Country:US
Mailing Address - Phone:860-916-5769
Mailing Address - Fax:
Practice Address - Street 1:40 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:RI
Practice Address - Zip Code:02813-3143
Practice Address - Country:US
Practice Address - Phone:860-916-5769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date: