Healthcare Provider Details

I. General information

NPI: 1730803297
Provider Name (Legal Business Name): MICHELLE Y. NEAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2022
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 EGGERT RD
BUFFALO NY
14215-3502
US

IV. Provider business mailing address

82 EGGERT RD
BUFFALO NY
14215-3502
US

V. Phone/Fax

Practice location:
  • Phone: 716-939-7309
  • Fax:
Mailing address:
  • Phone: 716-939-7309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number371248-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: