Healthcare Provider Details

I. General information

NPI: 1124809884
Provider Name (Legal Business Name): USHANANDHANI MOHANRAJ TLLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2023
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 CORPORATE OFFICE DR STE 300
MILFORD MI
48381-5002
US

IV. Provider business mailing address

30990 STONE RIDGE DR APT 10106
WIXOM MI
48393-3898
US

V. Phone/Fax

Practice location:
  • Phone: 248-714-9289
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6362010413
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: