Provider Demographics
NPI:1174172803
Name:MAURINA, MICHELLE DARLING (NP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DARLING
Last Name:MAURINA
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 1:800 MONTAUK HWY STE 18
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-2128
Mailing Address - Country:US
Mailing Address - Phone:631-772-4646
Mailing Address - Fax:
Practice Address - Street 1:800 MONTAUK HWY STE 8
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-2128
Practice Address - Country:US
Practice Address - Phone:631-772-4646
Practice Address - Fax:631-772-2495
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309273363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health