Healthcare Provider Details

I. General information

NPI: 1982313706
Provider Name (Legal Business Name): SARITA SHAUNTEL STRAIT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2022
Last Update Date: 11/21/2022
Certification Date: 11/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13575 LESURE ST
DETROIT MI
48227-3131
US

IV. Provider business mailing address

19763 VAUGHAN ST
DETROIT MI
48219-2010
US

V. Phone/Fax

Practice location:
  • Phone: 313-493-4410
  • Fax:
Mailing address:
  • Phone: 313-703-1299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number4704340534
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: