Healthcare Provider Details

I. General information

NPI: 1962108951
Provider Name (Legal Business Name): ALISHA DEMO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALISHA FRAIDENBURG FNP-C

II. Dates (important events)

Enumeration Date: 02/01/2023
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30600 TELEGRAPH RD STE 1160
BINGHAM FARMS MI
48025-4531
US

IV. Provider business mailing address

7240 CHASE OAKS BLVD
PLANO TX
75025-5901
US

V. Phone/Fax

Practice location:
  • Phone: 844-999-0020
  • Fax: 888-736-6686
Mailing address:
  • Phone: 844-999-9019
  • Fax: 214-291-5297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704343043
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: