Provider Demographics
NPI:1427338284
Name:DESROCHERS, MICHELLE (RD, CDN)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:DESROCHERS
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9201 SHORE RD APT D711
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-6596
Mailing Address - Country:US
Mailing Address - Phone:718-431-9891
Mailing Address - Fax:
Practice Address - Street 1:9201 SHORE RD APT D711
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-6596
Practice Address - Country:US
Practice Address - Phone:718-431-9891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY48007268133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered