Provider Demographics
NPI:1396459988
Name:LEE, MICHELLE JADE (PA-C)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:JADE
Last Name:LEE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 GUSTAVE L LEVY PL DEPT BOX 1259
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6504
Mailing Address - Country:US
Mailing Address - Phone:212-241-6500
Mailing Address - Fax:
Practice Address - Street 1:1090 AMSTERDAM AVE STE 10A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-1737
Practice Address - Country:US
Practice Address - Phone:212-523-4706
Practice Address - Fax:212-523-4720
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2025-08-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY029287363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical