Provider Demographics
NPI:1790947893
Name:BYSHEIM, MICHELLE A (RN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
Last Name:BYSHEIM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52380 COUNTY ROAD 48
Mailing Address - Street 2:
Mailing Address - City:SOUTHOLD
Mailing Address - State:NY
Mailing Address - Zip Code:11971-2644
Mailing Address - Country:US
Mailing Address - Phone:631-807-5819
Mailing Address - Fax:
Practice Address - Street 1:52380 COUNTY ROAD 48
Practice Address - Street 2:
Practice Address - City:SOUTHOLD
Practice Address - State:NY
Practice Address - Zip Code:11971-2644
Practice Address - Country:US
Practice Address - Phone:631-807-5819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22542538163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse