Healthcare Provider Details

I. General information

NPI: 1801581087
Provider Name (Legal Business Name): SHANNON M REYNOLDS BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 05/02/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3169 BEECHER ROAD
FLINT MI
48532
US

IV. Provider business mailing address

3169 BEECHER ROAD
FLINT MI
48532
US

V. Phone/Fax

Practice location:
  • Phone: 810-285-2312
  • Fax: 810-234-7022
Mailing address:
  • Phone: 810-285-2312
  • Fax: 810-234-7022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: