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General NPI Number Information
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NPI Number | 1033695176
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Entity Type | Individual
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Provider Name | SHAWNNAY DELISHA COOPER
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Gender | Female
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Dates
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Enumeration Date | 07/12/2018
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Last Update Date | 07/12/2018
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Provider Practice Location Address
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Address Line | 18635 FREELAND ST # 510
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City | DETROIT
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State | MI
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Zip | 48235-2541
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Country | US
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Telephone | 248-835-9363
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Fax |
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Provider Business Mailing Address
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Address Line | 32100 TELEGRAPH RD
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City | BINGHAM FARMS
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State | MI
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Zip | 48025-2452
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Country | US
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Telephone | 248-712-4266
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156F00000X
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Taxonomy Name | Technician/Technologist
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License Number |
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License Number State |
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