Healthcare Provider Details

I. General information

NPI: 1235081225
Provider Name (Legal Business Name): SHANEA MOSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2026
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24098 COUNTRY SQUIRE ST APT 227
CLINTON TWP MI
48035-3098
US

IV. Provider business mailing address

24098 COUNTRY SQUIRE ST APT 227
CLINTON TWP MI
48035-3098
US

V. Phone/Fax

Practice location:
  • Phone: 586-356-0459
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: