Provider Demographics
NPI:1578730354
Name:DI GUGLIELMO, MICHELLE (MD)
Entity Type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:
Last Name:DI GUGLIELMO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:473 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-4724
Mailing Address - Country:US
Mailing Address - Phone:516-318-5651
Mailing Address - Fax:
Practice Address - Street 1:473 S 4TH ST
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-4724
Practice Address - Country:US
Practice Address - Phone:516-318-5651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY256307207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology