Provider Demographics
NPI:1427675578
Name:BORRA, MICHELLE BALAGULAN (NP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:BALAGULAN
Last Name:BORRA
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 1:4210 COURT ROYALE APT 8
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12304-1848
Mailing Address - Country:US
Mailing Address - Phone:518-902-6328
Mailing Address - Fax:
Practice Address - Street 1:4210 COURT ROYALE APT 8
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12304-1848
Practice Address - Country:US
Practice Address - Phone:518-902-6328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-05
Last Update Date:2020-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY346044363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily