Provider Demographics
NPI:1619129764
Name:GILLILAND, MICHELLE MONIQUE (DNP)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:MONIQUE
Last Name:GILLILAND
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:M
Other - Last Name:SAXON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DNP
Mailing Address - Street 1:61 NORWALK AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14216-2879
Mailing Address - Country:US
Mailing Address - Phone:716-602-0619
Mailing Address - Fax:
Practice Address - Street 1:3980 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1727
Practice Address - Country:US
Practice Address - Phone:716-250-2000
Practice Address - Fax:716-250-2040
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY292797-1164W00000X
NY309116363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse