Healthcare Provider Details

I. General information

NPI: 1114018140
Provider Name (Legal Business Name): DR. MICHELE ANTOINETTE SCANTLEBURY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 BERRY ST
BROOKLYN NY
11249-3922
US

IV. Provider business mailing address

272 65TH ST APT 11F
BROOKLYN NY
11220-6512
US

V. Phone/Fax

Practice location:
  • Phone: 718-599-1202
  • Fax:
Mailing address:
  • Phone: 646-724-0150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number208050
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: