Healthcare Provider Details

I. General information

NPI: 1750674529
Provider Name (Legal Business Name): MONIKA RADHIKA WADEHRA MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 06/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6245 INKSTER RD
GARDEN CITY MI
48135-4001
US

IV. Provider business mailing address

30051 DEER RUN
FARMINGTON HILLS MI
48331-6011
US

V. Phone/Fax

Practice location:
  • Phone: 734-458-4272
  • Fax:
Mailing address:
  • Phone: 248-788-7903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: