Healthcare Provider Details

I. General information

NPI: 1063879369
Provider Name (Legal Business Name): PAYAL SHAH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2016
Last Update Date: 08/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31500 W 13 MILE RD STE 100
FARMINGTON HILLS MI
48334-2172
US

IV. Provider business mailing address

31500 W 13 MILE RD STE 100
FARMINGTON HILLS MI
48334-2172
US

V. Phone/Fax

Practice location:
  • Phone: 248-509-4070
  • Fax: 248-509-4080
Mailing address:
  • Phone: 248-509-4070
  • Fax: 248-509-4080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704278319
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: