MEDICARE: MICHELLE ODETTE NAZARIO M.D.

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	2084P0800X	Psychiatry Physician	260984	NY
2	2084P0800X	Psychiatry Physician	P6475	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861631236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE ODETTE NAZARIO M.D.

Provider Business Mailing Address
First Line	:	PO BOX 66308
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77266-6308
Country	:	US
Telephone Number	:	832-548-5076
Fax Number	:

Provider Business Practice Location Address
First Line	:	6500 ROOKIN ST STE 200
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-5019
Country	:	US
Telephone Number	:	713-351-7360
Fax Number	:

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

Provider Enumeration Date	:	02/09/2009
Last Update Date	:	06/26/2014

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