Healthcare Provider Details

I. General information

NPI: 1205780848
Provider Name (Legal Business Name): MICHELLE BOOKAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 SHERMAN AVE
NEW HAVEN CT
06511-5238
US

IV. Provider business mailing address

136 SHERMAN AVE STE 504
NEW HAVEN CT
06511-5294
US

V. Phone/Fax

Practice location:
  • Phone: 203-684-2111
  • Fax:
Mailing address:
  • Phone: 203-684-2111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number16031
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number16031
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: