MEDICARE: DR. MICHELLE BOBULINSKI PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	CT002359	CT
2	2084N0400X	Neurology Physician	CT002359	CT
3	103G00000X	Clinical Neuropsychologist	CT002359	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7226563	OTHER	CT	AETNA
2	060002359CT01	OTHER	CT	ANTHEM

General Provider Information

NPI Number	:	1346245420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE BOBULINSKI PH.D.

Provider Business Mailing Address
First Line	:	1202 LARSON DR
Second Line	:
City	:	DANBURY
State	:	CT
Zip	:	06810-7379
Country	:	US
Telephone Number	:	203-743-3973
Fax Number	:

Provider Business Practice Location Address
First Line	:	280 SOUTH MAIN STREET
Second Line	:	SUITE 102
City	:	CHESHIRE
State	:	CT
Zip	:	06410
Country	:	US
Telephone Number	:	860-870-6385
Fax Number	:	203-250-0191

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/19/2022

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