Provider Demographics
NPI:1033315544
Name:MICHNICK, ELYANE L (APRN)
Entity type:Individual
Prefix:MRS
First Name:ELYANE
Middle Name:L
Last Name:MICHNICK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:494 GENESEE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-3206
Mailing Address - Country:US
Mailing Address - Phone:718-948-3716
Mailing Address - Fax:
Practice Address - Street 1:6 CORPORATE DR
Practice Address - Street 2:SUITE 420
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-6270
Practice Address - Country:US
Practice Address - Phone:203-925-9600
Practice Address - Fax:203-926-0594
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY340647363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology