Individual
MRS. DONNA MICELI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
640 BELLE TERRE RD BLDG J, PRT JEFFERSON, NY 11777-1936
(631) 828-5361
Mailing address
33 LEEDS BLVD, FARMINGVILLE, NY 11738-1147
(631) 645-0006
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
261Q00000X
261Q00000X
—
Enumeration date
02/15/2023
Last updated
02/15/2023
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