Provider Demographics
NPI:1659635001
Name:BURCHETT, MICHELLE ANNE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANNE
Last Name:BURCHETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:DIFINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:126 JOHN ROLFE LN
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-1412
Mailing Address - Country:US
Mailing Address - Phone:914-262-3914
Mailing Address - Fax:
Practice Address - Street 1:6425 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-7202
Practice Address - Country:US
Practice Address - Phone:914-262-3914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-30
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2204000858235Z00000X
NY981004174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist