Healthcare Provider Details

I. General information

NPI: 1619613262
Provider Name (Legal Business Name): SHAYLA ALVINA MCMAHON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2022
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44405 WOODWARD AVE
PONTIAC MI
48341-5023
US

IV. Provider business mailing address

11750 SW 40TH ST
MIAMI FL
33175-3530
US

V. Phone/Fax

Practice location:
  • Phone: 248-858-3000
  • Fax:
Mailing address:
  • Phone: 305-222-5205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number5101029228
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: