Provider Demographics
NPI:1417585068
Name:CERESNIE, MARISSA SHAYNA (DO)
Entity type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:SHAYNA
Last Name:CERESNIE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29579 FOX GROVE RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-1947
Mailing Address - Country:US
Mailing Address - Phone:248-565-5288
Mailing Address - Fax:
Practice Address - Street 1:2110 RESEARCH ROW STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-2520
Practice Address - Country:US
Practice Address - Phone:214-530-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program