Provider Demographics
NPI:1427254697
Name:FUMAGALLI, MICHELLE (CPNP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:FUMAGALLI
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 W GARDEN RD
Mailing Address - Street 2:
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-1728
Mailing Address - Country:US
Mailing Address - Phone:914-834-2892
Mailing Address - Fax:
Practice Address - Street 1:1 ECHO HL
Practice Address - Street 2:
Practice Address - City:DOBBS FERRY
Practice Address - State:NY
Practice Address - Zip Code:10522-3600
Practice Address - Country:US
Practice Address - Phone:914-693-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF381642-1363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics