Provider Demographics
NPI:1770143711
Name:ENGEL, MICHELLE ALEXANDRA
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:ALEXANDRA
Last Name:ENGEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 POND LN
Mailing Address - Street 2:
Mailing Address - City:RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:11961-2634
Mailing Address - Country:US
Mailing Address - Phone:631-943-8689
Mailing Address - Fax:
Practice Address - Street 1:TWENTYNINE PALMS MARINE BASE
Practice Address - Street 2:1591
Practice Address - City:APO
Practice Address - State:AA
Practice Address - Zip Code:92278
Practice Address - Country:US
Practice Address - Phone:760-830-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program