Provider Demographics
NPI:1568725836
Name:VAUGHT, MICHELE E (MS)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:E
Last Name:VAUGHT
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 1:63 HIGHVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-1316
Mailing Address - Country:US
Mailing Address - Phone:347-677-8172
Mailing Address - Fax:
Practice Address - Street 1:63 HIGHVIEW AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-1316
Practice Address - Country:US
Practice Address - Phone:347-677-8172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist