Healthcare Provider Details

I. General information

NPI: 1275939373
Provider Name (Legal Business Name): MICHELLE LEE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2014
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 W 42ND ST
NEW YORK NY
10036-6982
US

IV. Provider business mailing address

2355 E GRAPEVINE MILLS CIR
GRAPEVINE TX
76051-2047
US

V. Phone/Fax

Practice location:
  • Phone: 646-518-0159
  • Fax:
Mailing address:
  • Phone: 972-539-6330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number18228
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: