Provider Demographics
NPI:1417415498
Name:XAVIER, SHEEJA (NP-C)
Entity Type:Individual
Prefix:
First Name:SHEEJA
Middle Name:
Last Name:XAVIER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4160 JOHN R ST STE 925
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2017
Mailing Address - Country:US
Mailing Address - Phone:313-745-7247
Mailing Address - Fax:313-993-0500
Practice Address - Street 1:4201 SAINT ANTOINE ST STE 5A
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2153
Practice Address - Country:US
Practice Address - Phone:313-745-3320
Practice Address - Fax:313-993-0080
Is Sole Proprietor?:No
Enumeration Date:2019-03-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704281225363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner