Provider Demographics
NPI:1639100548
Name:HUNTLEY, MICHELLE M (RD, CDE)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:HUNTLEY
Suffix:
Gender:
Credentials:RD, CDE
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:MARIE
Other - Last Name:LEBLANC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD, CDCES
Mailing Address - Street 1:591 CUMBERLAND ST
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-2402
Mailing Address - Country:US
Mailing Address - Phone:207-450-5531
Mailing Address - Fax:
Practice Address - Street 1:591 CUMBERLAND ST
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-2402
Practice Address - Country:US
Practice Address - Phone:207-450-5531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDI751133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0561Medicare ID - Type Unspecified
METX7847Medicare PIN