Provider Demographics
NPI:1447525738
Name:TAGAYUN, MICHELLE DERAY (RN)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:DERAY
Last Name:TAGAYUN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 VIRGINIA RD
Mailing Address - Street 2:APT 4E
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10603
Mailing Address - Country:US
Mailing Address - Phone:914-831-0190
Mailing Address - Fax:
Practice Address - Street 1:70 VIRGINIA RD
Practice Address - Street 2:APT 4E
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10603-1400
Practice Address - Country:US
Practice Address - Phone:914-831-0190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY560193163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse