Provider Demographics
NPI:1407669856
Name:BESHI, SERENA (PA-C)
Entity type:Individual
Prefix:
First Name:SERENA
Middle Name:
Last Name:BESHI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SERENA
Other - Middle Name:
Other - Last Name:BESHI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:7975 ELDORA
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48324-4722
Mailing Address - Country:US
Mailing Address - Phone:248-880-9787
Mailing Address - Fax:
Practice Address - Street 1:34025 HARPER AVE
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48035-3737
Practice Address - Country:US
Practice Address - Phone:586-445-9900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601012841363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant