Provider Demographics
NPI:1699084343
Name:SHIVACHI, VERONICA (NP-C)
Entity type:Individual
Prefix:MS
First Name:VERONICA
Middle Name:
Last Name:SHIVACHI
Suffix:
Gender:F
Credentials:NP-C
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Mailing Address - Street 1:24110 MEADOWBROOK RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-3459
Mailing Address - Country:US
Mailing Address - Phone:888-707-5716
Mailing Address - Fax:888-707-5716
Practice Address - Street 1:24110 MEADOWBROOK RD
Practice Address - Street 2:SUITE 206
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-3459
Practice Address - Country:US
Practice Address - Phone:888-707-5716
Practice Address - Fax:888-707-5716
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-29
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704245731363LA2200X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1699084343Medicaid