Healthcare Provider Details

I. General information

NPI: 1932855079
Provider Name (Legal Business Name): MICHELLE ESPOSITO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2022
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

485 FOLEY ST UNIT 542
SOMERVILLE MA
02145-1279
US

IV. Provider business mailing address

485 FOLEY ST UNIT 542
SOMERVILLE MA
02145-1279
US

V. Phone/Fax

Practice location:
  • Phone: 631-827-9378
  • Fax:
Mailing address:
  • Phone: 631-827-9378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN2353488
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: