Provider Demographics
NPI:1043007586
Name:SHINE, KESIA ELISE (ND, MBA, BSHA/IS)
Entity type:Individual
Prefix:
First Name:KESIA
Middle Name:ELISE
Last Name:SHINE
Suffix:
Gender:
Credentials:ND, MBA, BSHA/IS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15781 WILDEMERE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48238-1439
Mailing Address - Country:US
Mailing Address - Phone:602-460-7635
Mailing Address - Fax:
Practice Address - Street 1:15781 WILDEMERE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48238-1439
Practice Address - Country:US
Practice Address - Phone:602-460-7635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No171W00000XOther Service ProvidersContractor
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner
No374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel
No251B00000XAgenciesCase Management
No282J00000XHospitalsReligious Nonmedical Health Care Institution
No171WH0202XOther Service ProvidersContractorHome Modifications
No172V00000XOther Service ProvidersCommunity Health Worker
No174V00000XOther Service ProvidersClinical EthicistGroup - Multi-Specialty