Provider Demographics
NPI:1336717230
Name:SCHLITT, SHAYDA ELIZABETH (PA-C)
Entity type:Individual
Prefix:
First Name:SHAYDA
Middle Name:ELIZABETH
Last Name:SCHLITT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHAYDA
Other - Middle Name:
Other - Last Name:SORAYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:331 EDGEWOOD PL
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-2465
Mailing Address - Country:US
Mailing Address - Phone:248-904-9044
Mailing Address - Fax:
Practice Address - Street 1:6777 W MAPLE RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3013
Practice Address - Country:US
Practice Address - Phone:248-325-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-16
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601010595363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty