Provider Demographics
NPI:1285093674
Name:LAFERRIERE, MICHELLE LEE
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:LEE
Last Name:LAFERRIERE
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 1:80-45 WINCHESTER BLVD BUILD 73
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11427
Mailing Address - Country:US
Mailing Address - Phone:718-264-9310
Mailing Address - Fax:
Practice Address - Street 1:8045 WINCHESTER BLVD BLDG 73
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11427-2195
Practice Address - Country:US
Practice Address - Phone:718-264-3910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist