Individual
MISS MICHELLE RENE DEMENKOW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
14201 W SUNRISE BLVD, SUITE 208, SUNRISE, FL 33323-3207
(954) 851-9690
(954) 851-9688
Mailing address
14201 W SUNRISE BLVD STE 208, SUNRISE, FL 33323-3207
(954) 851-9690
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
PY6763
FL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
ARNP9211884
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
17568900
—
FL
Enumeration date
08/28/2007
Last updated
04/16/2020
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