Individual
THOMAS SHADAYA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
259 MACK AVE, DETROIT, MI 48201-2427
(313) 577-1716
Mailing address
259 MACK AVE, DETROIT, MI 48201-2427
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
4704272654
MI
367500000X
Certified Registered Nurse Anesthetist
Primary
4704272654
MI
Other
Enumeration date
07/07/2022
Last updated
03/19/2025
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