Provider Demographics
NPI:1518997295
Name:DOLSKE, MICHELLE COBB (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:COBB
Last Name:DOLSKE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:DENISE
Other - Last Name:COBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 607460
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32860-7460
Mailing Address - Country:US
Mailing Address - Phone:407-342-3636
Mailing Address - Fax:
Practice Address - Street 1:941 W MORSE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-3781
Practice Address - Country:US
Practice Address - Phone:407-342-3636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5341103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59827OtherBCBS
680011091OtherRAILROAD MEDICARE
FL59827YMedicare PIN