Provider Demographics
NPI:1013270958
Name:NUCCI, MICHELLE LAUREN (MSED)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:LAUREN
Last Name:NUCCI
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 SARAH DRIVE
Mailing Address - Street 2:
Mailing Address - City:OLD BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11804
Mailing Address - Country:US
Mailing Address - Phone:516-697-5524
Mailing Address - Fax:
Practice Address - Street 1:20 SARAH DR
Practice Address - Street 2:
Practice Address - City:OLD BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11804-1614
Practice Address - Country:US
Practice Address - Phone:516-697-5524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY490719OtherCERTIFICATION NUMBERS