Provider Demographics
NPI:1144110883
Name:SMITH, SHAYDEN (BSN, RN, CCRN)
Entity type:Individual
Prefix:
First Name:SHAYDEN
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:BSN, RN, CCRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S 1ST ST APT 625
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-1395
Mailing Address - Country:US
Mailing Address - Phone:601-770-9761
Mailing Address - Fax:
Practice Address - Street 1:201 S 1ST ST APT 625
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-1395
Practice Address - Country:US
Practice Address - Phone:601-770-9761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-04
Last Update Date:2025-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI4704426368163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program