MEDICARE: DR. MICHELLE ALBANO LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1063054252
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. MICHELLE ALBANO LLC

Provider Business Mailing Address
First Line	:	2390 SW 18TH AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33315-1812
Country	:	US
Telephone Number	:	954-465-6038
Fax Number	:

Provider Business Practice Location Address
First Line	:	7820 PETERS RD STE E100
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33324-4019
Country	:	US
Telephone Number	:	954-577-0095
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHELLE SCHULTZ ALBANO
Credential	:	PSY.D.
Telephone Number	:	954-465-6038

Provider Enumeration Date	:	10/09/2019
Last Update Date	:	10/09/2019

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