Healthcare Provider Details

I. General information

NPI: 1982897062
Provider Name (Legal Business Name): MAYYA SHIKHMAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 08/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 W GRAND BLVD DEPARTMENT OF UROLOGY
DETROIT MI
48202-2608
US

IV. Provider business mailing address

2799 W GRAND BLVD DEPARTMENT OF UROLOGY
DETROIT MI
48202-2608
US

V. Phone/Fax

Practice location:
  • Phone: 313-916-3221
  • Fax: 313-916-9926
Mailing address:
  • Phone: 313-916-3221
  • Fax: 313-916-9926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number4401000228
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601005075
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: