Healthcare Provider Details

I. General information

NPI: 1982085726
Provider Name (Legal Business Name): SHADIA YEIHEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 10/18/2021
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18101 OAKWOOD BLVD
DEARBORN MI
48124-4089
US

IV. Provider business mailing address

6698 KINGS MILL DR
CANTON MI
48187-5473
US

V. Phone/Fax

Practice location:
  • Phone: 313-436-2577
  • Fax:
Mailing address:
  • Phone: 313-410-9711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301108138
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: