=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710617311
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHALYNN RANGEL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2022
-----------------------------------------------------
Last Update Date | 02/28/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4880 LAWNDALE ST
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48210-2010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-846-3718
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 31131 W AMURCON
-----------------------------------------------------
City | FRASER
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48026-2766
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-675-1196
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 6851114834
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 6851114834
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------