Provider Demographics
NPI:1841882180
Name:SANDERS, MYA
Entity type:Individual
Prefix:
First Name:MYA
Middle Name:
Last Name:SANDERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38099 SCHOOLCRAFT RD STE 133
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-1029
Mailing Address - Country:US
Mailing Address - Phone:313-424-3216
Mailing Address - Fax:
Practice Address - Street 1:38099 SCHOOLCRAFT RD STE 133
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-1029
Practice Address - Country:US
Practice Address - Phone:313-424-3216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI57499101YP1600X
MI101YP1600X, 133N00000X
MI1424568133N00000X
MIUCJFQNS5FD173C00000X
MI1424567174400000X
174400000X, 173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No174400000XOther Service ProvidersSpecialist