Provider Demographics
NPI:1033851886
Name:DEJESUS, MICHELLE LYNN (DPM)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:DEJESUS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1183 NEW HAVEN RD
Mailing Address - Street 2:
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-5033
Mailing Address - Country:US
Mailing Address - Phone:203-723-7884
Mailing Address - Fax:203-723-2946
Practice Address - Street 1:1183 NEW HAVEN RD
Practice Address - Street 2:
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770-5033
Practice Address - Country:US
Practice Address - Phone:203-723-7884
Practice Address - Fax:203-723-2946
Is Sole Proprietor?:No
Enumeration Date:2022-04-12
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program