Provider Demographics
NPI:1639100548
Name:HUNTLEY, MICHELLE M (RD, CDE)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:HUNTLEY
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:MARIE
Other - Last Name:LEBLANC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD, CDE
Mailing Address - Street 1:15 SKY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND FORESIDE
Mailing Address - State:ME
Mailing Address - Zip Code:04110-1339
Mailing Address - Country:US
Mailing Address - Phone:207-781-4922
Mailing Address - Fax:207-781-4925
Practice Address - Street 1:15 SKY VIEW DR
Practice Address - Street 2:
Practice Address - City:CUMBERLAND FORESIDE
Practice Address - State:ME
Practice Address - Zip Code:04110-1339
Practice Address - Country:US
Practice Address - Phone:207-781-4922
Practice Address - Fax:207-781-4925
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDI751133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0561Medicare ID - Type Unspecified
METX7847Medicare PIN