Provider Demographics
NPI:1659987204
Name:MICHAEL, ELEONORA NESTORA
Entity Type:Individual
Prefix:MISS
First Name:ELEONORA
Middle Name:NESTORA
Last Name:MICHAEL
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 1:1 S POINT DR APT 312
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02125-3521
Mailing Address - Country:US
Mailing Address - Phone:401-408-0665
Mailing Address - Fax:
Practice Address - Street 1:17 GREENVILLE ST
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02119-2315
Practice Address - Country:US
Practice Address - Phone:617-445-6972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program