Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 2901022363 | MI |
Y | 213EG0000X | General Practice | 2901022363 | MI |
NPI | 1003334046 |
---|---|
Provider Name | Jomana Shayota |
First Address | Chelsea, MI 48118-1235 |
Second Address | Chelsea, MI 48118-1235 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2017 |
Last Update Date | 30/08/2017 |