Provider Demographics
NPI:1649720251
Name:MICHELLI, MICHAEL (AUD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:MICHELLI
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3605 SILVERSIDE RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-5101
Mailing Address - Country:US
Mailing Address - Phone:302-478-4942
Mailing Address - Fax:302-478-4169
Practice Address - Street 1:3605 SILVERSIDE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-5101
Practice Address - Country:US
Practice Address - Phone:302-478-4942
Practice Address - Fax:302-478-4169
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEO2-0000118231H00000X
PAAT001141L231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist