Provider Demographics
NPI:1619586682
Name:POWE, SAUNDRANITA REZIA (1744P3200X)
Entity type:Individual
Prefix:
First Name:SAUNDRANITA
Middle Name:REZIA
Last Name:POWE
Suffix:
Gender:F
Credentials:1744P3200X
Other - Prefix:MRS
Other - First Name:SAUNDRANITA
Other - Middle Name:REZIA
Other - Last Name:POWE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CERTIFIED HAIRLOSS
Mailing Address - Street 1:17535 CORAL GABLES AVE
Mailing Address - Street 2:
Mailing Address - City:LATHRUP VILLAGE
Mailing Address - State:MI
Mailing Address - Zip Code:48076-4603
Mailing Address - Country:US
Mailing Address - Phone:248-259-2757
Mailing Address - Fax:
Practice Address - Street 1:5642 W MAPLE RD STE 15
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3795
Practice Address - Country:US
Practice Address - Phone:248-259-2757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty