Healthcare Provider Details

I. General information

NPI: 1275928145
Provider Name (Legal Business Name): MICHELE NICOLE FIORENTINO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4735 OGLETOWN STANTON RD STE 3301
NEWARK DE
19713-7021
US

IV. Provider business mailing address

766 TORY HOLLOW RD
BERWYN PA
19312-1154
US

V. Phone/Fax

Practice location:
  • Phone: 302-623-4370
  • Fax: 302-623-4375
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number68115
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberC1-0027189
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: