Healthcare Provider Details

I. General information

NPI: 1326498890
Provider Name (Legal Business Name): SHEENA TAYLOR LLBSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 06/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 RIVER PLACE DR. SUITE 250 WAYNE CENTER
DETROIT MI
48207
US

IV. Provider business mailing address

251 STEVENS DR APT 302
YPSILANTI MI
48197-4529
US

V. Phone/Fax

Practice location:
  • Phone: 313-871-2337
  • Fax: 313-871-6655
Mailing address:
  • Phone: 734-833-8946
  • Fax: 313-871-6655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6802088875
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: