Provider Demographics
NPI:1093569493
Name:LYNK, SHAQUELLE (BS)
Entity Type:Individual
Prefix:
First Name:SHAQUELLE
Middle Name:
Last Name:LYNK
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8260 E HOLLYWOOD ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48234-3899
Mailing Address - Country:US
Mailing Address - Phone:313-649-0519
Mailing Address - Fax:
Practice Address - Street 1:8260 E HOLLYWOOD ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48234-3899
Practice Address - Country:US
Practice Address - Phone:313-649-0519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMI11012023839855376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide