Healthcare Provider Details

I. General information

NPI: 1245168418
Provider Name (Legal Business Name): MICHELLE MASIH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2026
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7764 BROOKDALE DR
WEST CHESTER OH
45069-3343
US

IV. Provider business mailing address

7764 BROOKDALE DR
WEST CHESTER OH
45069-3343
US

V. Phone/Fax

Practice location:
  • Phone: 240-476-4690
  • Fax:
Mailing address:
  • Phone: 240-476-4690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.010158RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: