Provider Demographics
NPI:1205622701
Name:OTTAVIO, MICHAEL DANIEL
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DANIEL
Last Name:OTTAVIO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 FOREST TURN
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3605
Mailing Address - Country:US
Mailing Address - Phone:516-477-9471
Mailing Address - Fax:
Practice Address - Street 1:600 HILL AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37210-4754
Practice Address - Country:US
Practice Address - Phone:615-329-4790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-19
Last Update Date:2025-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program