Healthcare Provider Details

I. General information

NPI: 1538655055
Provider Name (Legal Business Name): MS. SHOINE MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2018
Last Update Date: 07/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16127 RIVERVIEW ST
DETROIT MI
48219-3722
US

IV. Provider business mailing address

16127 RIVERVIEW ST
DETROIT MI
48219-3722
US

V. Phone/Fax

Practice location:
  • Phone: 313-721-0146
  • Fax:
Mailing address:
  • Phone: 313-721-0146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: