Provider Demographics
NPI:1962534545
Name:FUSTER, MICHELLE M (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:FUSTER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 CALLE ESPANA
Mailing Address - Street 2:OCEAN PARK
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00911-1430
Mailing Address - Country:US
Mailing Address - Phone:787-727-0538
Mailing Address - Fax:
Practice Address - Street 1:2059 CALLE LOIZA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00911-1733
Practice Address - Country:US
Practice Address - Phone:787-200-8684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-10
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8629235Z00000X
PR003066-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist