Healthcare Provider Details

I. General information

NPI: 1922312487
Provider Name (Legal Business Name): MEGHAN REGINA HARPER-SHANKIE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 03/10/2020
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28595 ORCHARD LAKE RD SUITE 200
FARMINGTON HILLS MI
48334-2977
US

IV. Provider business mailing address

26901 BEAUMONT BLVD STE 3D
SOUTHFIELD MI
48033-3849
US

V. Phone/Fax

Practice location:
  • Phone: 248-553-0010
  • Fax: 248-553-5957
Mailing address:
  • Phone: 947-522-1864
  • Fax: 947-522-0307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMT197524
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License Number4301104041
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: