Provider Demographics
NPI:1811027089
Name:MICHAELS, HEATHER SHANE (CGC)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:SHANE
Last Name:MICHAELS
Suffix:
Gender:F
Credentials:CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 E 30TH ST
Mailing Address - Street 2:APT. 17N
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6417
Mailing Address - Country:US
Mailing Address - Phone:212-725-2548
Mailing Address - Fax:
Practice Address - Street 1:343 E 30TH ST
Practice Address - Street 2:APT 17N
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6417
Practice Address - Country:US
Practice Address - Phone:212-725-2548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY99281170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS