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General NPI Number Information
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NPI Number | 1154393940
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Entity Type | Individual
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Provider Name | SHANNON ELIZABETH GRALEY D.O.
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Gender | Female
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Dates
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Enumeration Date | 02/06/2006
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 2215 FULLER RD
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City | ANN ARBOR
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State | MI
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Zip | 48105-2303
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Country | US
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Telephone | 734-769-7100
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Fax | 734-845-3408
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Provider Business Mailing Address
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Address Line | 2215 FULLER RD
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City | ANN ARBOR
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State | MI
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Zip | 48105-2303
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Country | US
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Telephone | 734-769-7100
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Fax | 734-845-3408
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 260251
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 52347
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5101016653
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License Number State | MI
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