Provider Demographics
NPI:1306399746
Name:PRAAY, SHANOA DIONE
Entity Type:Individual
Prefix:
First Name:SHANOA
Middle Name:DIONE
Last Name:PRAAY
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 1:4845 SNYDER AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:MI
Mailing Address - Zip Code:49412-8573
Mailing Address - Country:US
Mailing Address - Phone:231-924-6920
Mailing Address - Fax:
Practice Address - Street 1:4845 SNYDER AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:MI
Practice Address - Zip Code:49412-8573
Practice Address - Country:US
Practice Address - Phone:231-924-6920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301016676103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6301016676OtherLICENSE