MEDICARE: MICHELLE ELAINE ROSABELLA PA

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	363A00000X	Physician Assistant	001929	CT

General Provider Information

NPI Number	:	1750366613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE ELAINE ROSABELLA PA

Provider Business Mailing Address
First Line	:	42 ORCHARD ST
Second Line	:
City	:	THORNWOOD
State	:	NY
Zip	:	10594-2114
Country	:	US
Telephone Number	:	914-939-6219
Fax Number	:

Provider Business Practice Location Address
First Line	:	32 STRAWBERRY HILL CT
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06902-2594
Country	:	US
Telephone Number	:	203-977-2566
Fax Number	:

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

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	11/30/2010

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