Provider Demographics
NPI:1700610417
Name:PADY-MOISE, MICHELE (NP)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:PADY-MOISE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 VIRGINIA CIR
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-5151
Mailing Address - Country:US
Mailing Address - Phone:617-462-6734
Mailing Address - Fax:781-963-8992
Practice Address - Street 1:3 VIRGINIA CIR
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-5151
Practice Address - Country:US
Practice Address - Phone:617-462-6734
Practice Address - Fax:781-963-8992
Is Sole Proprietor?:No
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2263453363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health