MEDICARE: MRS. SHAINA LYNN DASGUPTA

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	374J00000X	Doula
2	246RP1900X	Phlebotomy Technician

General Provider Information

NPI Number	:	1639937600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHAINA LYNN DASGUPTA

Provider Business Mailing Address
First Line	:	2447 GLADSTONE ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48206-2239
Country	:	US
Telephone Number	:	313-208-5102
Fax Number	:

Provider Business Practice Location Address
First Line	:	2447 GLADSTONE ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48206-2239
Country	:	US
Telephone Number	:	313-208-5102
Fax Number	:

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

Provider Enumeration Date	:	03/13/2024
Last Update Date	:	11/25/2024

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