Healthcare Provider Details

I. General information

NPI: 1336248905
Provider Name (Legal Business Name): MALINI SHENAVA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 02/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6223 N CANTON CENTER RD SUITE 210
CANTON MI
48187-2696
US

IV. Provider business mailing address

6015 OAK TRL
WEST BLOOMFIELD MI
48322-2073
US

V. Phone/Fax

Practice location:
  • Phone: 734-737-1200
  • Fax:
Mailing address:
  • Phone: 734-737-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301065054
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: