Healthcare Provider Details

I. General information

NPI: 1992597579
Provider Name (Legal Business Name): RAKSHAYA VENU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2025
Last Update Date: 08/12/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N. EAST AVENUE
JACKSON MI
49201
US

IV. Provider business mailing address

205 N EAST AVENUE
JACKSON MI
49201
US

V. Phone/Fax

Practice location:
  • Phone: 517-205-7116
  • Fax: 517-205-7050
Mailing address:
  • Phone: 517-205-7116
  • Fax: 517-205-7050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4351054896
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: