Provider Demographics
NPI:1043005101
Name:SHAYA, BRENDA ANN
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:ANN
Last Name:SHAYA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 LAFONTAINE WAY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-4905
Mailing Address - Country:US
Mailing Address - Phone:810-496-6839
Mailing Address - Fax:810-496-6830
Practice Address - Street 1:6200 LAFONTAINE WAY
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-4905
Practice Address - Country:US
Practice Address - Phone:810-496-6839
Practice Address - Fax:810-496-6830
Is Sole Proprietor?:No
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53024171571835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist