Provider Demographics
NPI:1992398853
Name:PALYEKAR, SHREYA
Entity Type:Individual
Prefix:DR
First Name:SHREYA
Middle Name:
Last Name:PALYEKAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 WOODGATE DR APT 158
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-8227
Mailing Address - Country:US
Mailing Address - Phone:269-923-9041
Mailing Address - Fax:
Practice Address - Street 1:2720 WOODGATE DR
Practice Address - Street 2:APT 158
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085
Practice Address - Country:US
Practice Address - Phone:269-923-9041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX369751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice