Provider Demographics
NPI:1730826173
Name:PAREJA, MICHELLE NADHEZDA (BSW)
Entity type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:NADHEZDA
Last Name:PAREJA
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:NADHEZDA
Other - Last Name:SALCEDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2702 PORT CT
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34743-6050
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2431 ALOMA AVE STE 152
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-2541
Practice Address - Country:US
Practice Address - Phone:321-352-1715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator