Individual
MICHELLE SUZANNE HEDDERICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
401 PALMETTO ST, NEW SMYRNA BEACH, FL 32168-7322
(386) 424-5000
Mailing address
2679 WINNEMISSETT OAKS DR, DELAND, FL 32724-4862
(386) 424-5000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
13489
FL
207Q00000X
Family Medicine Physician
ME108171
FL
208M00000X
Hospitalist Physician
Primary
ME108171
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13489
TRN
FL
Enumeration date
07/06/2009
Last updated
12/06/2023
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