Healthcare Provider Details

I. General information

NPI: 1760107866
Provider Name (Legal Business Name): YEHUDIT MICHALSON-HAZAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2022
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5520 NW 31ST TER
GAINESVILLE FL
32653-1769
US

IV. Provider business mailing address

5520 NW 31ST TER
GAINESVILLE FL
32653-1769
US

V. Phone/Fax

Practice location:
  • Phone: 267-983-8544
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: