Healthcare Provider Details

I. General information

NPI: 1992668560
Provider Name (Legal Business Name): SASHA MANOOGIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2470 COLLINGWOOD ST
DETROIT MI
48206-1500
US

IV. Provider business mailing address

6279 SHADYDALE DR
SHELBY TWP MI
48316-6306
US

V. Phone/Fax

Practice location:
  • Phone: 586-260-7710
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: