MEDICARE: ALEXANDRIA VIRGINIA MICHAELS NP

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	163W00000X	Registered Nurse	773439-01	NY
2	363L00000X	Nurse Practitioner	310985	NY

General Provider Information

NPI Number	:	1609416742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRIA VIRGINIA MICHAELS NP

Provider Business Mailing Address
First Line	:	401 PLEASANT VALLEY RD
Second Line	:
City	:	LYONS
State	:	NY
Zip	:	14489-9724
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	335 PARRISH ST
Second Line	:
City	:	CANANDAIGUA
State	:	NY
Zip	:	14424-1794
Country	:	US
Telephone Number	:	585-393-2888
Fax Number	:

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

Provider Enumeration Date	:	01/07/2020
Last Update Date	:	08/14/2025

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