Provider Demographics
NPI:1851821060
Name:DIRADDO, MICHELLE L (PNP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:DIRADDO
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:L
Other - Last Name:EATON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE BOX 635
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-7787
Mailing Address - Fax:585-275-2352
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-275-2647
Practice Address - Fax:585-275-0707
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY382751208000000X, 363LP0200X
NY328751363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics