Healthcare Provider Details

I. General information

NPI: 1427243799
Provider Name (Legal Business Name): SALLY MICHELLE MICHAILIDES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SALLY MICHELLE MICHAILIDES-TWONSEND FNP

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 06/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 PROSPECT AVE SUITE 210
HUDSON NY
12534-2907
US

IV. Provider business mailing address

71 PROSPECT AVE SUITE 210
HUDSON NY
12534-2907
US

V. Phone/Fax

Practice location:
  • Phone: 518-943-1404
  • Fax:
Mailing address:
  • Phone: 518-943-1404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number396158-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF336227
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: