Provider Demographics
NPI:1407697220
Name:PACHON, MICHELLE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:PACHON
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 1:142 LOCUST LN
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:10533-2313
Mailing Address - Country:US
Mailing Address - Phone:914-306-0686
Mailing Address - Fax:
Practice Address - Street 1:142 LOCUST LN
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NY
Practice Address - Zip Code:10533-2313
Practice Address - Country:US
Practice Address - Phone:914-306-0686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029478-01225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist