Provider Demographics
NPI:1497137012
Name:WACHOB, SHREYA (DO)
Entity Type:Individual
Prefix:
First Name:SHREYA
Middle Name:
Last Name:WACHOB
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4851 E PICKARD ST STE 1760
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2038
Mailing Address - Country:US
Mailing Address - Phone:989-775-1625
Mailing Address - Fax:989-775-1640
Practice Address - Street 1:4851 E PICKARD ST STE 1760
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858
Practice Address - Country:US
Practice Address - Phone:989-775-1625
Practice Address - Fax:989-775-1640
Is Sole Proprietor?:No
Enumeration Date:2015-06-19
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101021901208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics