Provider Demographics
NPI:1235841263
Name:SHEENA, GEORGIA (PA-C)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:
Last Name:SHEENA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1576 COVINGTON RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFLD HLS
Mailing Address - State:MI
Mailing Address - Zip Code:48301-2372
Mailing Address - Country:US
Mailing Address - Phone:248-935-2377
Mailing Address - Fax:
Practice Address - Street 1:19725 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2584
Practice Address - Country:US
Practice Address - Phone:248-770-5205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-21
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601011479363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant