Provider Demographics
NPI:1518027929
Name:DIGGS, SHAUNA RYDER (MD,PC)
Entity Type:Individual
Prefix:DR
First Name:SHAUNA
Middle Name:RYDER
Last Name:DIGGS
Suffix:
Gender:F
Credentials:MD,PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 36293
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-0293
Mailing Address - Country:US
Mailing Address - Phone:313-882-5777
Mailing Address - Fax:313-882-5776
Practice Address - Street 1:17000 KERCHEVAL AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:GROSSE POINTE
Practice Address - State:MI
Practice Address - Zip Code:48230-1570
Practice Address - Country:US
Practice Address - Phone:313-882-5777
Practice Address - Fax:313-882-5776
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301064244207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG81411Medicare UPIN
MI0N93140Medicare ID - Type Unspecified