Provider Demographics
NPI:1689321192
Name:ALMON, SHANAE
Entity Type:Individual
Prefix:
First Name:SHANAE
Middle Name:
Last Name:ALMON
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 1:22452 FULLER DR
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-3780
Mailing Address - Country:US
Mailing Address - Phone:248-513-0016
Mailing Address - Fax:
Practice Address - Street 1:22452 FULLER DR
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-3780
Practice Address - Country:US
Practice Address - Phone:248-513-0016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-04
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service