Provider Demographics
NPI:1962287011
Name:MCARDLE, MICHELE A (RD)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:A
Last Name:MCARDLE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:A
Other - Last Name:MONTAGANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:181 WILLOWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793
Mailing Address - Country:US
Mailing Address - Phone:516-457-9549
Mailing Address - Fax:
Practice Address - Street 1:181 WILLOWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793
Practice Address - Country:US
Practice Address - Phone:516-457-9549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006456133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered