Healthcare Provider Details

I. General information

NPI: 1083558951
Provider Name (Legal Business Name): MICHELE ANTONUCCI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 BOSTON POST RD STE 1
ORANGE CT
06477-3534
US

IV. Provider business mailing address

362 FAIRLEA RD
ORANGE CT
06477-3411
US

V. Phone/Fax

Practice location:
  • Phone: 203-996-0950
  • Fax:
Mailing address:
  • Phone: 203-996-0950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZA2600X
TaxonomyMedical Art Specialist/Technologist
License Number980
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: