Provider Demographics
NPI:1306106356
Name:PADUA, MICHELLE (FNP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:PADUA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 ESPLANADE AVE
Mailing Address - Street 2:6C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1227
Mailing Address - Country:US
Mailing Address - Phone:347-621-5652
Mailing Address - Fax:
Practice Address - Street 1:1521 JARRET PL
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2606
Practice Address - Country:US
Practice Address - Phone:718-862-8840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33-336610363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily