Provider Demographics
NPI:1669684452
Name:MENARD, MICHELLE DIANE (AP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DIANE
Last Name:MENARD
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:957 LITTLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-7345
Mailing Address - Country:US
Mailing Address - Phone:407-421-7379
Mailing Address - Fax:
Practice Address - Street 1:11905 E COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-4725
Practice Address - Country:US
Practice Address - Phone:407-281-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2083171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist