Healthcare Provider Details

I. General information

NPI: 1497671952
Provider Name (Legal Business Name): SHAICANDIE MERCHANDISE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2026
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 CLOVERDALE ST APT A
JACKSON TN
38301-6979
US

IV. Provider business mailing address

52 CLOVERDALE ST APT A
JACKSON TN
38301-6979
US

V. Phone/Fax

Practice location:
  • Phone: 313-610-4401
  • Fax:
Mailing address:
  • Phone: 313-610-4401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MISS KAI BEATRICE-RAY FIELDS
Title or Position: SOCIAL WORKER
Credential: NP
Phone: 313-610-4401