Provider Demographics
NPI:1659523298
Name:SERVEDIO, MICHELLE (MS/ED)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:SERVEDIO
Suffix:
Gender:F
Credentials:MS/ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 CHESTNUT DR
Mailing Address - Street 2:
Mailing Address - City:UPPER SADDLE RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07458-2348
Mailing Address - Country:US
Mailing Address - Phone:845-721-7176
Mailing Address - Fax:
Practice Address - Street 1:40 FOREST GLEN RD
Practice Address - Street 2:
Practice Address - City:VALLEY COTTAGE
Practice Address - State:NY
Practice Address - Zip Code:10989-1200
Practice Address - Country:US
Practice Address - Phone:845-709-5181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-14
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist