Healthcare Provider Details

I. General information

NPI: 1184018327
Provider Name (Legal Business Name): MICHELLE SHENFELD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2015
Last Update Date: 05/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 VACCARO DR
CRESSKILL NJ
07626-1763
US

IV. Provider business mailing address

160 W END AVE APT 1N
NEW YORK NY
10023-5602
US

V. Phone/Fax

Practice location:
  • Phone: 201-463-0677
  • Fax:
Mailing address:
  • Phone: 201-463-0677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number092857
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: