MEDICARE: MICHELLE FUMAGALLI CPNP

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	363LP0200X	Pediatric Nurse Practitioner	F381642-1	NY

General Provider Information

NPI Number	:	1427254697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE FUMAGALLI CPNP

Provider Business Mailing Address
First Line	:	76 W GARDEN RD
Second Line	:
City	:	LARCHMONT
State	:	NY
Zip	:	10538-1728
Country	:	US
Telephone Number	:	914-834-2892
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 ECHO HL
Second Line	:
City	:	DOBBS FERRY
State	:	NY
Zip	:	10522-3600
Country	:	US
Telephone Number	:	914-693-0600
Fax Number	:

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

Provider Enumeration Date	:	06/25/2007
Last Update Date	:	07/08/2007

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