MEDICARE: MS. MICHELLE LI

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	363AM0700X	Medical Physician Assistant	018239	NY

General Provider Information

NPI Number	:	1932506094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELLE LI

Provider Business Mailing Address
First Line	:	4199 MAIN ST STE 201
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11355-5164
Country	:	US
Telephone Number	:	718-961-1897
Fax Number	:	718-766-9749

Provider Business Practice Location Address
First Line	:	4199 MAIN ST STE 201
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11355-5164
Country	:	US
Telephone Number	:	718-961-1897
Fax Number	:	718-766-9749

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

Provider Enumeration Date	:	12/04/2014
Last Update Date	:	08/15/2024

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Directions to “ MS. MICHELLE LI ” Practice Location

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