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General NPI Number Information
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NPI Number | 1477036242
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Entity Type | Individual
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Provider Name | MICHELLE D MAURY MSED
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Gender | Female
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Dates
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Enumeration Date | 09/07/2018
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Last Update Date | 01/04/2025
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Provider Practice Location Address
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Address Line | 933B MORRIS PARK AVE
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City | BRONX
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State | NY
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Zip | 10462-3711
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Country | US
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Telephone | 718-379-2229
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Fax |
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Provider Business Mailing Address
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Address Line | 4331 45TH ST APT 2B
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City | SUNNYSIDE
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State | NY
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Zip | 11104-2309
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Country | US
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Telephone | 914-309-7355
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 1285353181
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License Number State | NY
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