Provider Demographics
NPI:1730553819
Name:FRADI, SHIREEN (NP)
Entity type:Individual
Prefix:
First Name:SHIREEN
Middle Name:
Last Name:FRADI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4893 CREEK DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-3088
Mailing Address - Country:US
Mailing Address - Phone:586-567-5677
Mailing Address - Fax:
Practice Address - Street 1:33259 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-4628
Practice Address - Country:US
Practice Address - Phone:248-588-1885
Practice Address - Fax:248-928-0617
Is Sole Proprietor?:No
Enumeration Date:2015-11-30
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704283874364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health