Provider Demographics
NPI:1538652607
Name:FELDMAN, MICHELLE GABRIELLE (RD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:GABRIELLE
Last Name:FELDMAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 HUNGRY HARBOR RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-2537
Mailing Address - Country:US
Mailing Address - Phone:917-691-8511
Mailing Address - Fax:
Practice Address - Street 1:159 HUNGRY HARBOR RD
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-2537
Practice Address - Country:US
Practice Address - Phone:917-691-8511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty