Healthcare Provider Details

I. General information

NPI: 1710803176
Provider Name (Legal Business Name): SHAYLEE MARIE MENHENNICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 PRESQUE ISLE AVE
MARQUETTE MI
49855-2818
US

IV. Provider business mailing address

1121 KEEWAYDIN ST
NEGAUNEE MI
49866-1112
US

V. Phone/Fax

Practice location:
  • Phone: 906-227-1000
  • Fax:
Mailing address:
  • Phone: 906-235-1750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: