Provider Demographics
NPI:1548655046
Name:TEKKO, SHEIRAZ (MSN, CPNP-PC)
Entity type:Individual
Prefix:
First Name:SHEIRAZ
Middle Name:
Last Name:TEKKO
Suffix:
Gender:F
Credentials:MSN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2251 ANTIETAM AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-3879
Mailing Address - Country:US
Mailing Address - Phone:313-818-3654
Mailing Address - Fax:313-818-6385
Practice Address - Street 1:2251 ANTIETAM AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207
Practice Address - Country:US
Practice Address - Phone:313-818-3654
Practice Address - Fax:313-818-6385
Is Sole Proprietor?:No
Enumeration Date:2015-04-01
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704276630363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics