Provider Demographics
NPI:1063246247
Name:HEMINGWAY, MICHELLE F
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:F
Last Name:HEMINGWAY
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 1:1250 NIENBURG AVE NW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-1095
Mailing Address - Country:US
Mailing Address - Phone:321-447-1067
Mailing Address - Fax:
Practice Address - Street 1:1250 NIENBURG AVE NW
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-1095
Practice Address - Country:US
Practice Address - Phone:321-447-1067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician