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General NPI Number Information
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NPI Number | 1336915891
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Entity Type | Individual
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Provider Name | SHRADDHA JADHAV
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Gender | Female
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Dates
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Enumeration Date | 11/27/2023
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Last Update Date | 09/05/2024
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Provider Practice Location Address
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Address Line | 259 MACK AVE STE 2500
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City | DETROIT
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State | MI
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Zip | 48201-2427
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Country | US
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Telephone | 313-577-1716
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Fax |
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Provider Business Mailing Address
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Address Line | 259 MACK AVE STE 2500
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City | DETROIT
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State | MI
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Zip | 48201-2427
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Country | US
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Telephone | 313-577-1716
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 61581636
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 2084B0040X
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Taxonomy Name | Behavioral Neurology & Neuropsychiatry Physician
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License Number | 61581636
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License Number State | WA
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