Provider Demographics
NPI:1780569251
Name:TETER, MICHELLE (MS IN EDUCATION)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:TETER
Suffix:
Gender:F
Credentials:MS IN EDUCATION
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS IN EDUCATION
Mailing Address - Street 1:65 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-1131
Mailing Address - Country:US
Mailing Address - Phone:716-912-4390
Mailing Address - Fax:
Practice Address - Street 1:2980 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14227-1918
Practice Address - Country:US
Practice Address - Phone:716-892-2060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-06
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist