Healthcare Provider Details

I. General information

NPI: 1952925778
Provider Name (Legal Business Name): SHANYA STURDIVANT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2020
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 PACKARD RD STE 4
YPSILANTI MI
48197-2245
US

IV. Provider business mailing address

2086 S CUSTER RD
MONROE MI
48161-1831
US

V. Phone/Fax

Practice location:
  • Phone: 734-480-8099
  • Fax: 734-999-3779
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: