Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 104100000X | Social Worker | 6801099909 | MI |
Y | 104100000X | Social Worker | 6801104153 | MI |
NPI | 1003386335 |
---|---|
Provider Name | Poonam Shyam Melwani |
First Address | Southgate, MI 48195-2216 |
Second Address | Southgate, MI 48195-2216 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2018 |
Last Update Date | 03/07/2019 |