Healthcare Provider Details

I. General information

NPI: 1326587296
Provider Name (Legal Business Name): MICHELLE YANDO ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2017
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 MORRISTOWN CORNERS RD
MORRISVILLE VT
05661
US

IV. Provider business mailing address

PO BOX 1652
MORRISVILLE VT
05661-1652
US

V. Phone/Fax

Practice location:
  • Phone: 802-598-8575
  • Fax:
Mailing address:
  • Phone: 802-598-8575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: