Provider Demographics
NPI:1467873604
Name:DEMYAN, MICHELLE DIANE (MS)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:DIANE
Last Name:DEMYAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 LEEWAY CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-4515
Mailing Address - Country:US
Mailing Address - Phone:321-662-2780
Mailing Address - Fax:321-972-4589
Practice Address - Street 1:1065 LEEWAY CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-4515
Practice Address - Country:US
Practice Address - Phone:321-662-2780
Practice Address - Fax:321-972-4589
Is Sole Proprietor?:No
Enumeration Date:2013-12-13
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT1427106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist