Provider Demographics
NPI:1346555208
Name:MICHELIZZI, ELIZABETH SKAF (DMD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:SKAF
Last Name:MICHELIZZI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:SKAF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:227 AVALON CIR
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3863
Mailing Address - Country:US
Mailing Address - Phone:631-838-1944
Mailing Address - Fax:
Practice Address - Street 1:500 PORTION RD STE 16
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-4587
Practice Address - Country:US
Practice Address - Phone:631-451-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-16
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014149841223G0001X
NY059045-11223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice