Healthcare Provider Details

I. General information

NPI: 1821288168
Provider Name (Legal Business Name): MICHELLE L HERNANDEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 05/10/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 CENTRAL DR
SANFORD NC
27330-4159
US

IV. Provider business mailing address

2000 PERIMETER PARK DR STE 200
MORRISVILLE NC
27560-8442
US

V. Phone/Fax

Practice location:
  • Phone: 919-718-9512
  • Fax: 919-718-9516
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number2007-01177
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: