Provider Demographics
NPI:1700072832
Name:FLEISHMAN, MICHELLE DENICE (NURSE LPN)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:DENICE
Last Name:FLEISHMAN
Suffix:
Gender:F
Credentials:NURSE LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 COUNTY HIGHWAY 24
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:13439-4719
Mailing Address - Country:US
Mailing Address - Phone:315-858-2435
Mailing Address - Fax:
Practice Address - Street 1:36 BEECHNUT TER
Practice Address - Street 2:
Practice Address - City:WHITESBORO
Practice Address - State:NY
Practice Address - Zip Code:13492-1704
Practice Address - Country:US
Practice Address - Phone:315-736-6015
Practice Address - Fax:315-768-9606
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY284225-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02902445OtherMEDICAID PROVIDER NUMBER