Individual provider Active NPI

Michelle Danielle Stewart

  • Licensed Practical Nurse
  • Blue Point, NY
National Provider Identifier
1083434286
Registry record updated Oct 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
WAITING Issued in NY
Practice address
263 Blue Point Ave
Blue Point, NY 11715-1224
Phone
(631) 419-6737
Fax
(631) 868-3498
NPI assigned
Oct 12, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X WAITING NY Primary

Addresses

Primary practice location

263 Blue Point Ave
Blue Point, NY 11715-1224

Mailing address

865 Broadway Ave Apt 217B
Holbrook, NY 11741-4929
Phone (631) 295-8150

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
WAITINGNYMDLicensed Practical Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1728691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728691200000",
    "number": "1083434286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "865 BROADWAY AVE APT 217B",
            "city": "HOLBROOK",
            "state": "NY",
            "postal_code": "117414929",
            "telephone_number": "631-295-8150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "263 BLUE POINT AVE",
            "city": "BLUE POINT",
            "state": "NY",
            "postal_code": "117151224",
            "telephone_number": "631-419-6737",
            "fax_number": "631-868-3498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEWART",
        "first_name": "MICHELLE",
        "middle_name": "DANIELLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-10-12",
        "last_updated": "2024-10-12",
        "certification_date": "2024-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "WAITING",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Blue Point, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.