Provider Demographics
NPI:1245344852
Name:PRESTI, MICHAEL SHAYNE (DPM)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SHAYNE
Last Name:PRESTI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 STEVENAGE CT
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009
Mailing Address - Country:US
Mailing Address - Phone:410-676-1877
Mailing Address - Fax:
Practice Address - Street 1:1500 BLENHIEM FARM LN STE C
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-2042
Practice Address - Country:US
Practice Address - Phone:410-939-0055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01342213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU87023Medicare UPIN
MD448P879GMedicare PIN