Healthcare Provider Details

I. General information

NPI: 1134595184
Provider Name (Legal Business Name): SHAWN MCGRANDY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2015
Last Update Date: 08/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3253 CONGRESS AVE
SAGINAW MI
48602-3106
US

IV. Provider business mailing address

3253 CONGRESS AVE
SAGINAW MI
48602-3106
US

V. Phone/Fax

Practice location:
  • Phone: 989-793-4790
  • Fax: 989-793-1641
Mailing address:
  • Phone: 989-793-4790
  • Fax: 989-793-1641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: