Healthcare Provider Details

I. General information

NPI: 1639100548
Provider Name (Legal Business Name): MICHELLE M HUNTLEY RD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE MARIE LEBLANC RD, CDCES

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

591 CUMBERLAND ST
WESTBROOK ME
04092-2402
US

IV. Provider business mailing address

591 CUMBERLAND ST
WESTBROOK ME
04092-2402
US

V. Phone/Fax

Practice location:
  • Phone: 207-450-5531
  • Fax:
Mailing address:
  • Phone: 207-450-5531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI751
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: