Healthcare Provider Details

I. General information

NPI: 1295648202
Provider Name (Legal Business Name): SHAMIJAH BOYKINS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4022 MILBOURNE AVE
FLINT MI
48504-2212
US

IV. Provider business mailing address

4022 MILBOURNE AVE
FLINT MI
48504-2212
US

V. Phone/Fax

Practice location:
  • Phone: 810-662-6193
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number4703127145
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: