Healthcare Provider Details

I. General information

NPI: 1104515998
Provider Name (Legal Business Name): MICHELLE NOURMAND MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2023
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 NORTHERN BLVD STE 201
GREAT NECK NY
11021-5338
US

IV. Provider business mailing address

720 MIDDLE NECK RD APT 4W
GREAT NECK NY
11024-1951
US

V. Phone/Fax

Practice location:
  • Phone: 516-824-4588
  • Fax:
Mailing address:
  • Phone: 516-423-2901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: