Provider Demographics
NPI:1467842237
Name:ATKINSON, MICHELE DIANE (MSED)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:DIANE
Last Name:ATKINSON
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:HOLTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11742-1608
Mailing Address - Country:US
Mailing Address - Phone:631-879-8401
Mailing Address - Fax:
Practice Address - Street 1:10 BROADWAY
Practice Address - Street 2:
Practice Address - City:HOLTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11742-1608
Practice Address - Country:US
Practice Address - Phone:631-879-8401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist