Provider Demographics
NPI:1760226997
Name:CHARLES-NIEVES, MICHELLE VICTORIA (ABO-AC, NCLEC)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:VICTORIA
Last Name:CHARLES-NIEVES
Suffix:
Gender:F
Credentials:ABO-AC, NCLEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 SENATOR LN
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-1151
Mailing Address - Country:US
Mailing Address - Phone:609-850-9701
Mailing Address - Fax:
Practice Address - Street 1:13 SENATOR LN
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08016-1151
Practice Address - Country:US
Practice Address - Phone:609-850-9701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31TD00418500156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician