Healthcare Provider Details

I. General information

NPI: 1033747902
Provider Name (Legal Business Name): MICHELLE ANTELO DENADEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE NICOLE DOMINI MD

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 9TH AVE
SEATTLE WA
98101-2756
US

IV. Provider business mailing address

PO BOX 741515
LOS ANGELES CA
90074-1515
US

V. Phone/Fax

Practice location:
  • Phone: 206-223-6191
  • Fax: 206-625-7274
Mailing address:
  • Phone: 206-223-6191
  • Fax: 206-625-7274

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 StateWA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD61542859
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: