Provider Demographics
NPI:1952811333
Name:VANNOSTRAND, MICHAEL PATRICK (MS)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:PATRICK
Last Name:VANNOSTRAND
Suffix:
Gender:M
Credentials:MS
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Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:104 CANDLEWOOD GDNS
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-2646
Mailing Address - Country:US
Mailing Address - Phone:518-332-5752
Mailing Address - Fax:
Practice Address - Street 1:505 IRVING AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1718
Practice Address - Country:US
Practice Address - Phone:315-464-9966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist