Provider Demographics
NPI:1457601478
Name:SWIDERSKI, MICHELLE LEE (MS ED TSHH)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEE
Last Name:SWIDERSKI
Suffix:
Gender:F
Credentials:MS ED TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:SCHENEVUS
Mailing Address - State:NY
Mailing Address - Zip Code:12155-0008
Mailing Address - Country:US
Mailing Address - Phone:607-638-5050
Mailing Address - Fax:
Practice Address - Street 1:28 ARCH STREET
Practice Address - Street 2:
Practice Address - City:SCHENEVUS
Practice Address - State:NY
Practice Address - Zip Code:12155-0008
Practice Address - Country:US
Practice Address - Phone:607-638-5050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY384135031174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist