Provider Demographics
NPI:1588855340
Name:FERRANDINO, MICHELLE AUDREY (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:AUDREY
Last Name:FERRANDINO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CAMERON AVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566
Mailing Address - Country:US
Mailing Address - Phone:516-867-5425
Mailing Address - Fax:
Practice Address - Street 1:51 ST ANDREWS LA
Practice Address - Street 2:CLIENTS HOME
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2252
Practice Address - Country:US
Practice Address - Phone:516-656-0557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY125539164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02192818Medicaid