Provider Demographics
NPI:1720841190
Name:LEMON, SHAMERE D
Entity Type:Individual
Prefix:
First Name:SHAMERE
Middle Name:D
Last Name:LEMON
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 1:11758 WILSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48213-1619
Mailing Address - Country:US
Mailing Address - Phone:313-704-3239
Mailing Address - Fax:
Practice Address - Street 1:20235 SAN JUAN DR
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-1276
Practice Address - Country:US
Practice Address - Phone:313-704-3239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care