Provider Demographics
NPI:1760773006
Name:FELDMAN, MICHELLE ELIZABETH (DO)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ELIZABETH
Last Name:FELDMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3876 BEVERLY AVE NE BLDG F
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-1319
Mailing Address - Country:US
Mailing Address - Phone:503-588-5352
Mailing Address - Fax:
Practice Address - Street 1:3876 BEVERLY AVE NE BLDG F
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1319
Practice Address - Country:US
Practice Address - Phone:503-588-5352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-20
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO1933642084P0804X
MN647992084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry