Provider Demographics
NPI:1205407723
Name:WATSON, SHANI LEE
Entity Type:Individual
Prefix:
First Name:SHANI
Middle Name:LEE
Last Name:WATSON
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 1:9621 BELDING RD
Mailing Address - Street 2:
Mailing Address - City:BELDING
Mailing Address - State:MI
Mailing Address - Zip Code:48809-9254
Mailing Address - Country:US
Mailing Address - Phone:616-302-8926
Mailing Address - Fax:
Practice Address - Street 1:9621 BELDING RD
Practice Address - Street 2:
Practice Address - City:BELDING
Practice Address - State:MI
Practice Address - Zip Code:48809-9254
Practice Address - Country:US
Practice Address - Phone:616-302-8926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health