Healthcare Provider Details

I. General information

NPI: 1972178648
Provider Name (Legal Business Name): MICHELLE RODRIGUEZ AGUAYO M.D., MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE RODRIGUEZ

II. Dates (important events)

Enumeration Date: 05/25/2021
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date: 03/29/2023
Reactivation Date: 08/11/2023

III. Provider practice location address

1250 SILVER ST
MIDDLETOWN CT
06457-3946
US

IV. Provider business mailing address

1250 SILVER ST
MIDDLETOWN CT
06457-3946
US

V. Phone/Fax

Practice location:
  • Phone: 860-420-2622
  • Fax:
Mailing address:
  • Phone: 860-420-2622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD21057
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: