Provider Demographics
NPI:1649086851
Name:MASON, SANIYAH (CHW)
Entity type:Individual
Prefix:
First Name:SANIYAH
Middle Name:
Last Name:MASON
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 RIVER FOREST DR APT 1144
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-2809
Mailing Address - Country:US
Mailing Address - Phone:810-252-3837
Mailing Address - Fax:
Practice Address - Street 1:225 E 5TH ST STE 300
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48502-1641
Practice Address - Country:US
Practice Address - Phone:810-406-4246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI122434461172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker