Provider Demographics
NPI:1871761536
Name:GUIDRY, MICHAEL J (MS)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:GUIDRY
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 WINDMILL LN
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22307-1946
Mailing Address - Country:US
Mailing Address - Phone:703-765-2442
Mailing Address - Fax:
Practice Address - Street 1:6521 ARLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-3016
Practice Address - Country:US
Practice Address - Phone:703-538-4161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist