Doctor Name: | MISS MICHELLE MARY FAZZOLARI |
NPI Number: | 1417381088 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS ED. |
License Number: | 473873369 |
Business Practice Address: | 436 Willis Ave Williston Park, NY - 115962298 |
Business Phone Number: | 5162330144 |
Business Fax Number: | |
Mailing Address: | 436 Willis Ave, WILLISTON PARK |
State: | NY |
Postal Code: | 115962298 |
Phone Number: | 5162330144 |
Fax Number: | |
NPI Enumeration Date: | 08/30/2013 |
NPI Last Update Date: | 08/30/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 473873369 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NY |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |