Healthcare Provider Details

I. General information

NPI: 1255681938
Provider Name (Legal Business Name): SHERINA ANNE HYMAN PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHERINA ANNE DANIEL PA-C

II. Dates (important events)

Enumeration Date: 09/11/2012
Last Update Date: 02/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44201 DEQUINDRE RD EMERGENCY DEPT.
TROY MI
48085-1117
US

IV. Provider business mailing address

38935 ANN ARBOR RD CREDENTIALING DEPT.
LIVONIA MI
48150-3397
US

V. Phone/Fax

Practice location:
  • Phone: 248-964-6410
  • Fax:
Mailing address:
  • Phone: 734-632-0175
  • Fax: 734-632-0182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601006454
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: