Active NPI
Michelle Rozana Bacchus, PA
- Physician Assistant
- Hewlett, NY
National Provider Identifier
1316600745
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 011819
- Practice address
- 1800 Rockaway Ave Ste 100
Hewlett, NY 11557-1666 - Phone
- (516) 887-4343
- Fax
- (516) 887-8569
- NPI assigned
- Oct 21, 2021
- Last updated
- Sep 30, 2026
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 011819 | NY | Primary |
Addresses
Primary practice location
1800 Rockaway Ave Ste 100
Hewlett, NY 11557-1666
Mailing address
266 Pontiac PL
East Meadow, NY 11554-1230
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
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 011819 | NY | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1634774400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1790726400000",
"number": "1316600745",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "266 PONTIAC PL",
"city": "EAST MEADOW",
"state": "NY",
"postal_code": "115541230"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1800 ROCKAWAY AVE STE 100",
"city": "HEWLETT",
"state": "NY",
"postal_code": "115571666",
"telephone_number": "516-887-4343",
"fax_number": "516-887-8569"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BACCHUS",
"first_name": "MICHELLE",
"middle_name": "ROZANA",
"name_prefix": "Mrs.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-10-21",
"last_updated": "2026-09-30",
"certification_date": "2026-09-30",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "011819",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hewlett, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.