Provider Demographics
NPI:1851924211
Name:ANDERSON, SHEUSHEA
Entity Type:Individual
Prefix:
First Name:SHEUSHEA
Middle Name:
Last Name:ANDERSON
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 1:22444 MEADOW WOODS CIR # A
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-3599
Mailing Address - Country:US
Mailing Address - Phone:313-585-2002
Mailing Address - Fax:313-879-3838
Practice Address - Street 1:11255 ALLEN RD APT 204
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2880
Practice Address - Country:US
Practice Address - Phone:313-585-2002
Practice Address - Fax:313-879-3838
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-13
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health