MEDICARE: SHYRA SHAQUANDA BLAKE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide	802411452	MI

General Provider Information

NPI Number	:	1033081625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHYRA SHAQUANDA BLAKE

Provider Business Mailing Address
First Line	:	1059 RIVER FOREST DR
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48532-2803
Country	:	US
Telephone Number	:	810-610-6332
Fax Number	:

Provider Business Practice Location Address
First Line	:	1059 RIVER FOREST DR
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48532-2803
Country	:	US
Telephone Number	:	810-610-6332
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2025
Last Update Date	:	09/22/2025

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Directions to “ SHYRA SHAQUANDA BLAKE ” Practice Location

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