Provider Demographics
NPI:1497454417
Name:TINSLEY, SHONTAVIA
Entity Type:Individual
Prefix:
First Name:SHONTAVIA
Middle Name:
Last Name:TINSLEY
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 1:29155 POINTE O WOODS PL APT 208
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1247
Mailing Address - Country:US
Mailing Address - Phone:313-303-8621
Mailing Address - Fax:
Practice Address - Street 1:29155 POINTE O WOODS PL APT 208
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1247
Practice Address - Country:US
Practice Address - Phone:313-303-8621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health