Provider Demographics
NPI:1174185458
Name:GREGORY, SHALA
Entity Type:Individual
Prefix:
First Name:SHALA
Middle Name:
Last Name:GREGORY
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:G3500 FLUSHING RD STE 244
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48504-4235
Mailing Address - Country:US
Mailing Address - Phone:810-820-7390
Mailing Address - Fax:
Practice Address - Street 1:G3500 FLUSHING RD STE 244
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504-4235
Practice Address - Country:US
Practice Address - Phone:810-820-7390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMI000016572376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide