Provider Demographics
NPI:1730521774
Name:FOUANI, SHIRYL DEEN (CERTIFIED NURSE ASIS)
Entity type:Individual
Prefix:MRS
First Name:SHIRYL
Middle Name:DEEN
Last Name:FOUANI
Suffix:
Gender:F
Credentials:CERTIFIED NURSE ASIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81153 BURLINGAME ST.
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202
Mailing Address - Country:US
Mailing Address - Phone:313-444-3493
Mailing Address - Fax:
Practice Address - Street 1:4553 MEAD ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3011
Practice Address - Country:US
Practice Address - Phone:313-850-7109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-18
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI230014007150308374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide