Healthcare Provider Details

I. General information

NPI: 1699524942
Provider Name (Legal Business Name): SHANIKA BROWN BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANIKA STEEN BA

II. Dates (important events)

Enumeration Date: 05/17/2024
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 WOODWARD AVE
DETROIT MI
48202-2142
US

IV. Provider business mailing address

21760 BEECHWOOD AVE
EASTPOINTE MI
48021-2102
US

V. Phone/Fax

Practice location:
  • Phone: 888-360-9355
  • Fax:
Mailing address:
  • Phone: 586-209-8107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: