MEDICARE: SHAUNTEL DYE

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	311ZA0620X	Adult Care Home Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700533304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAUNTEL DYE

Provider Business Mailing Address
First Line	:	3925 SPRUCE ST
Second Line	:
City	:	INKSTER
State	:	MI
Zip	:	48141-2921
Country	:	US
Telephone Number	:	248-499-3151
Fax Number	:

Provider Business Practice Location Address
First Line	:	8536 WARD ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48228-4037
Country	:	US
Telephone Number	:	248-382-8185
Fax Number	:

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

Provider Enumeration Date	:	03/04/2022
Last Update Date	:	03/04/2022

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Directions to “ SHAUNTEL DYE ” Practice Location

Language	Start Address	Practice Location

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