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NPI Code Detail

MEDICARE: MRS. MICHELLE ELAINE CAVALLARO MS CCC-SLP

MEDICARE: MRS. MICHELLE ELAINE CAVALLARO MS CCC-SLP
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
1235Z00000XSpeech-Language Pathologist7736-1NY

General Provider Information

NPI Number : 1790087641
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MICHELLE ELAINE CAVALLARO MS CCC-SLP
Provider Business Mailing Address
First Line : 184 CROSBY LN
Second Line :
City : ROCHESTER
State : NY
Zip : 14612-3328
Country : US
Telephone Number : 585-581-2251
Fax Number :
Provider Business Practice Location Address
First Line : 690 SAINT PAUL ST
Second Line :
City : ROCHESTER
State : NY
Zip : 14605-1709
Country : US
Telephone Number : 585-262-8636
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2010
Last Update Date : 11/29/2010

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