Healthcare Provider Details

I. General information

NPI: 1902268402
Provider Name (Legal Business Name): MICHAEL PIGNATIELLO PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2619 COMMONS BLVD
BEAVERCREEK OH
45431-3817
US

IV. Provider business mailing address

PO BOX 340453
DAYTON OH
45434-0453
US

V. Phone/Fax

Practice location:
  • Phone: 937-280-4970
  • Fax:
Mailing address:
  • Phone: 937-280-4970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4369
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: