Healthcare Provider Details

I. General information

NPI: 1316799281
Provider Name (Legal Business Name): MS. SHATERIA MICHELLE BOONE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26791 SILVER CREEK CT
BROWNSTOWN MI
48134-1182
US

IV. Provider business mailing address

26791 SILVER CREEK CT
BROWNSTOWN MI
48134-1182
US

V. Phone/Fax

Practice location:
  • Phone: 313-304-0408
  • Fax: 866-551-4017
Mailing address:
  • Phone: 313-304-0408
  • Fax: 866-551-4017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704229347
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: