Provider Demographics
NPI:1811546898
Name:ZELIKMAN, MICHELLE RENE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RENE
Last Name:ZELIKMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 ROSEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-1384
Mailing Address - Country:US
Mailing Address - Phone:978-406-4618
Mailing Address - Fax:
Practice Address - Street 1:300 ROSEWOOD DR
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1384
Practice Address - Country:US
Practice Address - Phone:978-406-4618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA127295133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered