Provider Demographics
NPI:1386300358
Name:SI, MICHELLE XUEJIA (NP)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:XUEJIA
Last Name:SI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4469 KISSENA BLVD APT 3L
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-7006
Mailing Address - Country:US
Mailing Address - Phone:347-593-0536
Mailing Address - Fax:
Practice Address - Street 1:4469 KISSENA BLVD APT 3L
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-7006
Practice Address - Country:US
Practice Address - Phone:347-593-0536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310542363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health