Healthcare Provider Details

I. General information

NPI: 1003623257
Provider Name (Legal Business Name): MICHAELA MARIE FIBRAIO CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2024
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 VILLAGE RD E
WEST WINDSOR NJ
08550-2400
US

IV. Provider business mailing address

5623 RAVENS CREST DR
PLAINSBORO NJ
08536-2443
US

V. Phone/Fax

Practice location:
  • Phone: 732-425-3293
  • Fax:
Mailing address:
  • Phone: 732-425-3293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number41YS01288900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: