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General NPI Number Information
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NPI Number | 1962435271
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Entity Type | Organization
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Legal Business Name | MICHELLE R DEMENKOW, PA
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 05/20/2020
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Provider Practice Location Address
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Address Line | 14201 W SUNRISE BLVD STE 208
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City | SUNRISE
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State | FL
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Zip | 33323
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Country | US
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Telephone | 954-851-9690
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Fax | 954-366-5056
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Provider Business Mailing Address
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Address Line | 14201 W SUNRISE BLVD STE 208
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City | SUNRISE
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State | FL
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Zip | 33323-3207
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Country | US
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Telephone | 954-851-9690
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHELLE R DEMENKOW
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Credential | PH.D.
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Telephone | 954-856-8703
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY6763
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | ARNP9211884
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License Number State | FL
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