Provider Demographics
NPI:1659416675
Name:TRINIDAD, MICHELE MILAGROS (PA)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:MILAGROS
Last Name:TRINIDAD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:68 HALL DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-2543
Mailing Address - Country:US
Mailing Address - Phone:203-215-9384
Mailing Address - Fax:
Practice Address - Street 1:2000 POST RD
Practice Address - Street 2:SUITE 202
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5730
Practice Address - Country:US
Practice Address - Phone:203-254-9454
Practice Address - Fax:203-254-0152
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001615363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant