Craddock, Michelle Marilyn

Craddock, Michelle Marilyn is an sole proprietor health care provider with primary practice located at 625 Belle Terre Rd Suite 119 Port Jefferson Medical Assoc, Port Jefferson NY 11777. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Craddock, Michelle Marilyn can be contacted via phone (631) 642-0609.

Contact Information

Primary practice address
625 Belle Terre Rd Suite 119 Port Jefferson Medical Assoc Port Jefferson NY 11777
Phone: (631) 642-0609
Fax: (631) 642-0588
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X F3325721 New York

Profile Details

NPI number 1013182112
LBN Legal business name Craddock, Michelle Marilyn
Credentials Adult Nurse Practitioner (ANP)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 29th, 2008
Last updated Apr 29th, 2008 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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