MEDICARE: DR. MICHELLE SARAH YUSUPOV ND

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	175F00000X	Naturopath	000626	CT

General Provider Information

NPI Number	:	1851860993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE SARAH YUSUPOV ND

Provider Business Mailing Address
First Line	:	67 MEADOW LN
Second Line	:
City	:	ROSLYN HEIGHTS
State	:	NY
Zip	:	11577-2340
Country	:	US
Telephone Number	:	516-477-4771
Fax Number	:

Provider Business Practice Location Address
First Line	:	1533 PITKIN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11212-4516
Country	:	US
Telephone Number	:	516-477-4771
Fax Number	:

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

Provider Enumeration Date	:	11/19/2018
Last Update Date	:	11/19/2018

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