MEDICARE: MICHELLE D MAURY MSED

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	1285353181	NY

General Provider Information

NPI Number	:	1477036242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE D MAURY MSED

Provider Business Mailing Address
First Line	:	4331 45TH ST APT 2B
Second Line	:
City	:	SUNNYSIDE
State	:	NY
Zip	:	11104-2309
Country	:	US
Telephone Number	:	914-309-7355
Fax Number	:

Provider Business Practice Location Address
First Line	:	933B MORRIS PARK AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-3711
Country	:	US
Telephone Number	:	718-379-2229
Fax Number	:

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

Provider Enumeration Date	:	09/07/2018
Last Update Date	:	01/04/2025

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