Provider Demographics
NPI:1447512314
Name:NELSON, MICHELLE
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:NELSON
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 1:100 DARROW PL APT 4C
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-1867
Mailing Address - Country:US
Mailing Address - Phone:646-851-9521
Mailing Address - Fax:
Practice Address - Street 1:100 DARROW PL APT 4C
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-1867
Practice Address - Country:US
Practice Address - Phone:646-851-9521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist