Healthcare Provider Details

I. General information

NPI: 1841882180
Provider Name (Legal Business Name): MYA SANDERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2021
Last Update Date: 02/08/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38099 SCHOOLCRAFT RD STE 133
LIVONIA MI
48150-1029
US

IV. Provider business mailing address

38099 SCHOOLCRAFT RD STE 133
LIVONIA MI
48150-1029
US

V. Phone/Fax

Practice location:
  • Phone: 313-424-3216
  • Fax:
Mailing address:
  • Phone: 313-424-3216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number57499
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number1424568
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License NumberUCJFQNS5FD
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number1424567
License Number StateMI
# 7
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: