Provider Demographics
NPI:1629608526
Name:DURAN, MICHELLE NOEMI
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:NOEMI
Last Name:DURAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10850 HEATHER RIDGE CIR APT 108
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-3348
Mailing Address - Country:US
Mailing Address - Phone:813-598-5887
Mailing Address - Fax:
Practice Address - Street 1:10850 HEATHER RIDGE CIR APT 108
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-3348
Practice Address - Country:US
Practice Address - Phone:813-598-5887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-19
Last Update Date:2020-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician