Healthcare Provider Details

I. General information

NPI: 1154239861
Provider Name (Legal Business Name): MICHAELA DANIELCZYK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 NORTH AVE
BURLINGTON VT
05408-2804
US

IV. Provider business mailing address

339 GARDEN ST UNIT 401
SOUTH BURLINGTON VT
05403-4221
US

V. Phone/Fax

Practice location:
  • Phone: 802-863-1313
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number026.0154927
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: