MEDICARE: MRS. MICHELLE SKIDMORE

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	363LA2200X	Adult Health Nurse Practitioner	312340	NY

General Provider Information

NPI Number	:	1326997800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHELLE SKIDMORE

Provider Business Mailing Address
First Line	:	2 CAXTON ST
Second Line	:
City	:	MELVILLE
State	:	NY
Zip	:	11747-1605
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 PORT WASHINGTON BLVD
Second Line	:
City	:	ROSLYN
State	:	NY
Zip	:	11576-1353
Country	:	US
Telephone Number	:	516-562-6000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2026
Last Update Date	:	01/27/2026

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Directions to “ MRS. MICHELLE SKIDMORE ” Practice Location

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