Provider Demographics
NPI:1023261021
Name:BUCK-O'MEALLY, MICHELLE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:BUCK-O'MEALLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 E BURNSIDE AVE
Mailing Address - Street 2:APT 6-D
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-3729
Mailing Address - Country:US
Mailing Address - Phone:718-538-2622
Mailing Address - Fax:
Practice Address - Street 1:270 E BURNSIDE AVE
Practice Address - Street 2:APT 6-D
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-3729
Practice Address - Country:US
Practice Address - Phone:718-538-2622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY279691164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse