Healthcare Provider Details

I. General information

NPI: 1760989685
Provider Name (Legal Business Name): MICHELE WADUD MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2018
Last Update Date: 04/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 BUIST RD
MILFORD PA
18337-9311
US

IV. Provider business mailing address

468 CRESTMONT DR
NEWFOUNDLAND PA
18445-5202
US

V. Phone/Fax

Practice location:
  • Phone: 570-296-1138
  • Fax:
Mailing address:
  • Phone: 570-252-4417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: