Healthcare Provider Details

I. General information

NPI: 1174446876
Provider Name (Legal Business Name): AMANDA MIKHO FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47226 CAYLEE DR
SHELBY TOWNSHIP MI
48315-5057
US

IV. Provider business mailing address

47226 CAYLEE DR
SHELBY TOWNSHIP MI
48315-5057
US

V. Phone/Fax

Practice location:
  • Phone: 586-360-8860
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704397991
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: