Healthcare Provider Details

I. General information

NPI: 1720790116
Provider Name (Legal Business Name): SILVANA XHAJAJ FNP, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SILVANA ULDEDAJ FNP, BC

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3270 GREENFIELD RD
BERKLEY MI
48072-1161
US

IV. Provider business mailing address

16336 FOREST WAY
MACOMB MI
48042-2349
US

V. Phone/Fax

Practice location:
  • Phone: 248-268-1525
  • Fax:
Mailing address:
  • Phone: 586-804-1286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704357147
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: