Provider Demographics
NPI:1154822583
Name:FLEET, SHAWN MARIE (BA MOD, MOAM)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:MARIE
Last Name:FLEET
Suffix:
Gender:F
Credentials:BA MOD, MOAM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7730 20 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SAND LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49343-9494
Mailing Address - Country:US
Mailing Address - Phone:616-450-6350
Mailing Address - Fax:
Practice Address - Street 1:260 LEONARD ST NW STE 2
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-4267
Practice Address - Country:US
Practice Address - Phone:616-458-9520
Practice Address - Fax:616-458-9532
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator