Healthcare Provider Details

I. General information

NPI: 1639430804
Provider Name (Legal Business Name): MICHELLE HERNANDEZ M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2012
Last Update Date: 06/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2709 HEATH AVE 4B
BRONX NY
10463-7537
US

IV. Provider business mailing address

2709 HEATH AVE 4B
BRONX NY
10463-7537
US

V. Phone/Fax

Practice location:
  • Phone: 718-601-7214
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: