Healthcare Provider Details

I. General information

NPI: 1679213029
Provider Name (Legal Business Name): BRIAN SHAYAN DANESHVAR D.O., M.M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44725 GRAND RIVER AVE STE 104
NOVI MI
48375-1024
US

IV. Provider business mailing address

44725 GRAND RIVER AVE STE 104
NOVI MI
48375-1024
US

V. Phone/Fax

Practice location:
  • Phone: 844-623-0508
  • Fax: 248-232-6152
Mailing address:
  • Phone: 844-623-0508
  • Fax: 248-232-6152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number5101027863
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: