Healthcare Provider Details

I. General information

NPI: 1447547302
Provider Name (Legal Business Name): MICHELLE BINDER JONELIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2011
Last Update Date: 09/29/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SHORELINE HWY STE 100
MILL VALLEY CA
94941-3645
US

IV. Provider business mailing address

775 E BLITHEDALE AVE # 615
MILL VALLEY CA
94941-1554
US

V. Phone/Fax

Practice location:
  • Phone: 415-226-9389
  • Fax: 415-728-9764
Mailing address:
  • Phone: 415-226-9389
  • Fax: 415-728-9764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License NumberA118288
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: