Provider Demographics
NPI:1982313706
Name:STRAIT, SARITA SHAUNTEL
Entity Type:Individual
Prefix:
First Name:SARITA
Middle Name:SHAUNTEL
Last Name:STRAIT
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 1:19763 VAUGHAN ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-2010
Mailing Address - Country:US
Mailing Address - Phone:313-703-1299
Mailing Address - Fax:
Practice Address - Street 1:13575 LESURE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227-3131
Practice Address - Country:US
Practice Address - Phone:313-493-4410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704340534163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)