Healthcare Provider Details

I. General information

NPI: 1053014530
Provider Name (Legal Business Name): MICHELLE PACYNA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 QUINCY AVE
DUNMORE PA
18510-1150
US

IV. Provider business mailing address

1140 QUINCY AVE
DUNMORE PA
18510-1150
US

V. Phone/Fax

Practice location:
  • Phone: 570-983-0360
  • Fax:
Mailing address:
  • Phone: 570-983-0360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS026221
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: