Provider Demographics
NPI:1780429829
Name:EVES-ACTON, SHAYNE ANITA
Entity type:Individual
Prefix:
First Name:SHAYNE
Middle Name:ANITA
Last Name:EVES-ACTON
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 1:414 N 21ST ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:49037-7802
Mailing Address - Country:US
Mailing Address - Phone:269-275-5617
Mailing Address - Fax:
Practice Address - Street 1:210 E LEROY ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MI
Practice Address - Zip Code:49029-9794
Practice Address - Country:US
Practice Address - Phone:269-339-1037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-29
Last Update Date:2024-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician