Healthcare Provider Details

I. General information

NPI: 1427254697
Provider Name (Legal Business Name): MICHELLE FUMAGALLI CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ECHO HL
DOBBS FERRY NY
10522-3600
US

IV. Provider business mailing address

76 W GARDEN RD
LARCHMONT NY
10538-1728
US

V. Phone/Fax

Practice location:
  • Phone: 914-693-0600
  • Fax:
Mailing address:
  • Phone: 914-834-2892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberF381642-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: