Provider Demographics
NPI:1578251310
Name:COLEY, MICHELINE DENISE (MS, LAC, HC)
Entity Type:Individual
Prefix:
First Name:MICHELINE
Middle Name:DENISE
Last Name:COLEY
Suffix:
Gender:F
Credentials:MS, LAC, HC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WASHINGTON AVE APT 120
Mailing Address - Street 2:
Mailing Address - City:WYANDANCH
Mailing Address - State:NY
Mailing Address - Zip Code:11798-2442
Mailing Address - Country:US
Mailing Address - Phone:631-645-1492
Mailing Address - Fax:
Practice Address - Street 1:1 WASHINGTON AVE
Practice Address - Street 2:APT 120
Practice Address - City:WYANDANCH
Practice Address - State:NY
Practice Address - Zip Code:11798-2442
Practice Address - Country:US
Practice Address - Phone:631-645-1492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007280-1171100000X
NY171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No171400000XOther Service ProvidersHealth & Wellness Coach