Individual
MRS. MICHELLE FORDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1444 5TH AVE, BAY SHORE, NY 11706-4147
(631) 647-2048
Mailing address
1444 5TH AVE, BAY SHORE, NY 11706-4147
(631) 647-2048
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
F401746
NY
Other
Enumeration date
07/31/2014
Last updated
07/29/2015
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