Healthcare Provider Details

I. General information

NPI: 1336717230
Provider Name (Legal Business Name): SHAYDA ELIZABETH SCHLITT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHAYDA SORAYA

II. Dates (important events)

Enumeration Date: 06/16/2021
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6777 W MAPLE RD
WEST BLOOMFIELD MI
48322-3013
US

IV. Provider business mailing address

331 EDGEWOOD PL
FERNDALE MI
48220-2465
US

V. Phone/Fax

Practice location:
  • Phone: 248-325-1000
  • Fax:
Mailing address:
  • Phone: 248-904-9044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601010595
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: