MEDICARE: HADASSAH SANDRA MCKNIGHT ED.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1245182682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HADASSAH SANDRA MCKNIGHT ED.D

Provider Business Mailing Address
First Line	:	1973 GOLF RIDGE DR
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48302-1724
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10201 W 7 MILE RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48221-1903
Country	:	US
Telephone Number	:	313-340-2224
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2026
Last Update Date	:	02/10/2026

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