Healthcare Provider Details

I. General information

NPI: 1639935976
Provider Name (Legal Business Name): DARSHENA SHANIKA BRYANT PHLEBOTOMIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 02/26/2024
Certification Date: 02/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16000 W 9 MILE RD STE 510
SOUTHFIELD MI
48075-4850
US

IV. Provider business mailing address

16000 W 9 MILE RD STE 510
SOUTHFIELD MI
48075-4850
US

V. Phone/Fax

Practice location:
  • Phone: 855-504-7873
  • Fax: 248-436-9011
Mailing address:
  • Phone: 855-504-7873
  • Fax: 248-436-9011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number8944237786
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: