Healthcare Provider Details

I. General information

NPI: 1760828495
Provider Name (Legal Business Name): MICHELLE ANN DOLEZAL M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2013
Last Update Date: 08/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2277 GOSHEN TPKE
MIDDLETOWN NY
10941-4032
US

IV. Provider business mailing address

14 LIBERTY CT
WASHINGTONVILLE NY
10992-1305
US

V. Phone/Fax

Practice location:
  • Phone: 845-692-4391
  • Fax: 845-692-4397
Mailing address:
  • Phone: 845-527-8430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number023238
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: