Provider Demographics
NPI:1134569940
Name:MCHUGH, MICHELLE IRENE (MA TVI)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:IRENE
Last Name:MCHUGH
Suffix:
Gender:F
Credentials:MA TVI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 MIDDLESEX AVE
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11769-1951
Mailing Address - Country:US
Mailing Address - Phone:516-238-9669
Mailing Address - Fax:516-238-9669
Practice Address - Street 1:105 MIDDLESEX AVE
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:NY
Practice Address - Zip Code:11769-1951
Practice Address - Country:US
Practice Address - Phone:516-238-9669
Practice Address - Fax:516-238-9669
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY709310174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist