Provider Demographics
NPI:1225164577
Name:SHREM, TANYA PAULA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TANYA
Middle Name:PAULA
Last Name:SHREM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31330 NORTHWESTERN HWY
Mailing Address - Street 2:SUITE D
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2560
Mailing Address - Country:US
Mailing Address - Phone:248-788-7081
Mailing Address - Fax:248-737-9963
Practice Address - Street 1:31330 NORTHWESTERN HWY
Practice Address - Street 2:SUITE D
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2560
Practice Address - Country:US
Practice Address - Phone:248-788-7081
Practice Address - Fax:248-737-9963
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010632103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N15570Medicare ID - Type UnspecifiedMEDICARE PROVIDER