Provider Demographics
NPI:1740208099
Name:SCOTT, SHANEY L (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANEY
Middle Name:L
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 419
Mailing Address - Street 2:
Mailing Address - City:CHEBOYGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49721-0419
Mailing Address - Country:US
Mailing Address - Phone:231-627-1438
Mailing Address - Fax:231-627-1471
Practice Address - Street 1:740 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CHEBOYGAN
Practice Address - State:MI
Practice Address - Zip Code:49721-2220
Practice Address - Country:US
Practice Address - Phone:231-627-5601
Practice Address - Fax:231-627-1846
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301057706207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI010A660000OtherGROUP BLUE CROSS
MI0101600192OtherINDIVIDUAL BLUE CROSS
MI4866274Medicaid
G07441Medicare UPIN
MI4866274Medicaid