Provider Demographics
NPI:1770391724
Name:DEASFERNANDEZ, SIRFORNIA (PHD)
Entity type:Individual
Prefix:DR
First Name:SIRFORNIA
Middle Name:
Last Name:DEASFERNANDEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6443 FLORENCE LN
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48111-5270
Mailing Address - Country:US
Mailing Address - Phone:313-457-5934
Mailing Address - Fax:
Practice Address - Street 1:6443 FLORENCE LN
Practice Address - Street 2:
Practice Address - City:VAN BUREN TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48111-5270
Practice Address - Country:US
Practice Address - Phone:313-457-5934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1241406848171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach