Provider Demographics
NPI:1912206525
Name:FYNAN, MICHELLE L
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:FYNAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:L
Other - Last Name:BUNKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4244 CENTRAL AVENUE NORTH
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33711-1140
Mailing Address - Country:US
Mailing Address - Phone:727-308-6094
Mailing Address - Fax:727-250-5142
Practice Address - Street 1:4244 CENTRAL AVENUE NORTH
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711
Practice Address - Country:US
Practice Address - Phone:727-308-6094
Practice Address - Fax:727-250-5142
Is Sole Proprietor?:No
Enumeration Date:2011-03-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health