Organization
MICHELLE R DEMENKOW, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHELLE R DEMENKOW PH.D. (OWNER)
(954) 856-8703
Entity
Organization
Contact information
Practice address
14201 W SUNRISE BLVD STE 208, SUNRISE, FL 33323
(954) 851-9690
(954) 366-5056
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
Enumeration date
07/09/2006
Last updated
05/20/2020
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