Provider Demographics
NPI:1710617311
Name:RANGEL, SHALYNN
Entity Type:Individual
Prefix:
First Name:SHALYNN
Middle Name:
Last Name:RANGEL
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 1:31131 W AMURCON
Mailing Address - Street 2:
Mailing Address - City:FRASER
Mailing Address - State:MI
Mailing Address - Zip Code:48026-2766
Mailing Address - Country:US
Mailing Address - Phone:586-675-1196
Mailing Address - Fax:
Practice Address - Street 1:4880 LAWNDALE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48210-2010
Practice Address - Country:US
Practice Address - Phone:313-846-3718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-15
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
68511148341041C0700X
MI68511148341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical