Healthcare Provider Details

I. General information

NPI: 1326549148
Provider Name (Legal Business Name): SHENICAK KUJUANA DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2018
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16434 CONSTANCE AVE
DETROIT MI
48228-4311
US

IV. Provider business mailing address

16434 CONSTANCE AVE
DETROIT MI
48228-4311
US

V. Phone/Fax

Practice location:
  • Phone: 313-455-2910
  • Fax:
Mailing address:
  • Phone: 313-455-2910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: