Provider Demographics
NPI:1972382109
Name:DACTO, MICHELLE NATHALIE (NP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:NATHALIE
Last Name:DACTO
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 1:6006 80TH AVE # 1
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-6029
Mailing Address - Country:US
Mailing Address - Phone:718-581-9689
Mailing Address - Fax:
Practice Address - Street 1:6006 80TH AVE # 1
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-6029
Practice Address - Country:US
Practice Address - Phone:718-581-9689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY432720363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care