Provider Demographics
NPI:1083408041
Name:MANORANJITHAN, SHAMINY ANNE
Entity type:Individual
Prefix:
First Name:SHAMINY
Middle Name:ANNE
Last Name:MANORANJITHAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4069 LAKE DR SE STE 312
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-8816
Mailing Address - Country:US
Mailing Address - Phone:616-267-8700
Mailing Address - Fax:
Practice Address - Street 1:4069 LAKE DR SE STE 312
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8816
Practice Address - Country:US
Practice Address - Phone:616-267-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program