MEDICARE: TYISHA D MICHEL

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	104100000X	Social Worker	SW11065	FL

General Provider Information

NPI Number	:	1912401811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYISHA D MICHEL

Provider Business Mailing Address
First Line	:	1250 NE 202ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33179-2625
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1250 NE 202ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33179-2625
Country	:	US
Telephone Number	:	305-788-8498
Fax Number	:

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

Provider Enumeration Date	:	03/23/2018
Last Update Date	:	03/23/2018

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Directions to “ TYISHA D MICHEL ” Practice Location

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