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General NPI Number Information
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NPI Number | 1063641520
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Entity Type | Individual
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Provider Name | MICHELLE SUZANNE HEDDERICH M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/06/2009
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Last Update Date | 12/06/2023
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Provider Practice Location Address
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Address Line | 401 PALMETTO ST
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32168-7322
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Country | US
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Telephone | 386-424-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 2679 WINNEMISSETT OAKS DR
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City | DELAND
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State | FL
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Zip | 32724-4862
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Country | US
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Telephone | 386-424-5000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME108171
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 13489
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | ME108171
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License Number State | FL
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