Provider Demographics
NPI:1053095729
Name:O'CONNOR, MICHELLE AZRA
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:AZRA
Last Name:O'CONNOR
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 1:1637 JOHNSON ST APT S1
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-4149
Mailing Address - Country:US
Mailing Address - Phone:201-660-4189
Mailing Address - Fax:
Practice Address - Street 1:18480 NW 19TH ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-3823
Practice Address - Country:US
Practice Address - Phone:786-376-5812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician