Provider Demographics
NPI:1801581087
Name:REYNOLDS, SHANNON M (BS)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:M
Last Name:REYNOLDS
Suffix:
Gender:
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3169 BEECHER ROAD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532
Mailing Address - Country:US
Mailing Address - Phone:810-285-2312
Mailing Address - Fax:810-234-7022
Practice Address - Street 1:3169 BEECHER ROAD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532
Practice Address - Country:US
Practice Address - Phone:810-285-2312
Practice Address - Fax:810-234-7022
Is Sole Proprietor?:No
Enumeration Date:2023-04-05
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI171M00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator