Individual
MRS. MICHELLE DISCHIAVO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
623 NEW LOUDON RD, LATHAM, NY 12110-4031
(518) 782-1178
Mailing address
70 OLD LOUDON RD, LATHAM, NY 12110-4005
(518) 785-3739
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
NY
Other
Enumeration date
03/26/2007
Last updated
07/26/2007
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