Provider Demographics
NPI:1851860993
Name:YUSUPOV, MICHELLE SARAH (ND)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:SARAH
Last Name:YUSUPOV
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-2340
Mailing Address - Country:US
Mailing Address - Phone:516-477-4771
Mailing Address - Fax:
Practice Address - Street 1:1533 PITKIN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-4516
Practice Address - Country:US
Practice Address - Phone:516-477-4771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000626175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath