Healthcare Provider Details

I. General information

NPI: 1336872662
Provider Name (Legal Business Name): SHREYA NAGARKAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2022
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 JOHN ST STE 100
KALAMAZOO MI
49007-5317
US

IV. Provider business mailing address

601 JOHN ST STE 100
KALAMAZOO MI
49007-5317
US

V. Phone/Fax

Practice location:
  • Phone: 269-373-1222
  • Fax: 269-373-6270
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601013841
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085011832
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: