Provider Demographics
NPI:1982476743
Name:SHONDA PETERSON
Entity Type:Organization
Organization Name:SHONDA PETERSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH AND WELLNESS COACH
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-465-3439
Mailing Address - Street 1:20251 HUNT CLUB DR
Mailing Address - Street 2:
Mailing Address - City:HARPER WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48225-1761
Mailing Address - Country:US
Mailing Address - Phone:313-465-3439
Mailing Address - Fax:
Practice Address - Street 1:20251 HUNT CLUB DR
Practice Address - Street 2:
Practice Address - City:HARPER WOODS
Practice Address - State:MI
Practice Address - Zip Code:48225-1761
Practice Address - Country:US
Practice Address - Phone:313-465-3439
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-25
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty