Provider Demographics
NPI:1437543485
Name:FLESHER, SHANE
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:
Last Name:FLESHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 E THORNRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT MORRIS
Mailing Address - State:MI
Mailing Address - Zip Code:48458-9121
Mailing Address - Country:US
Mailing Address - Phone:810-620-5281
Mailing Address - Fax:
Practice Address - Street 1:257 E THORNRIDGE LN
Practice Address - Street 2:
Practice Address - City:MOUNT MORRIS
Practice Address - State:MI
Practice Address - Zip Code:48458-9121
Practice Address - Country:US
Practice Address - Phone:810-620-5281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst