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General NPI Number Information
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NPI Number | 1609393735
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Entity Type | Individual
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Provider Name | MANSI SHARADKUMAR MEHTA
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Gender | Female
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Dates
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Enumeration Date | 08/29/2017
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 705 S MAIN ST
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City | PLYMOUTH
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State | MI
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Zip | 48170-2089
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Country | US
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Telephone | 734-454-3560
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Fax | 832-324-6751
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Provider Business Mailing Address
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Address Line | 37875 W 12 MILE RD STE 208
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City | FARMINGTON HILLS
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State | MI
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Zip | 48331-3053
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Country | US
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Telephone | 734-251-2662
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Fax | 832-324-6751
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN.CNP.021452
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704327956
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN.CNP.021452
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 4704327956
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License Number State | MI
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