Provider Demographics
NPI:1831925817
Name:MICELI, CHRISTINA ALEXANDRA
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ALEXANDRA
Last Name:MICELI
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 1:1410 ASTORIA PARK S
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-3733
Mailing Address - Country:US
Mailing Address - Phone:860-685-1133
Mailing Address - Fax:
Practice Address - Street 1:2707 8TH ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-4218
Practice Address - Country:US
Practice Address - Phone:718-721-3960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program