Provider Demographics
NPI:1740604826
Name:ALLEN, MICHELE ELIZABETH (MSED)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:ELIZABETH
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4402 RICHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-3936
Mailing Address - Country:US
Mailing Address - Phone:716-200-6771
Mailing Address - Fax:
Practice Address - Street 1:790 RIDGE RD
Practice Address - Street 2:
Practice Address - City:LACKAWANNA
Practice Address - State:NY
Practice Address - Zip Code:14218-1629
Practice Address - Country:US
Practice Address - Phone:716-822-4781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208888081174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist