Healthcare Provider Details

I. General information

NPI: 1023590346
Provider Name (Legal Business Name): MICHELLE THOMASCH PATEL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2018
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 YORK AVE
NEW YORK NY
10065-6007
US

IV. Provider business mailing address

69 5TH AVE APT 15A
NEW YORK NY
10003-3009
US

V. Phone/Fax

Practice location:
  • Phone: 212-639-2323
  • Fax:
Mailing address:
  • Phone: 978-807-4610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN1030092
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number124708
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: