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General NPI Number Information
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NPI Number | 1891588232
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Entity Type | Individual
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Provider Name | SHAFONTA HAYDEN
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Gender | Female
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Dates
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Enumeration Date | 05/28/2025
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 19959 RIOPELLE ST
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City | DETROIT
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State | MI
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Zip | 48203-1249
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Country | US
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Telephone | 586-980-0090
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Fax | 586-980-0090
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Provider Business Mailing Address
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Address Line | 19959 RIOPELLE ST
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City | DETROIT
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State | MI
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Zip | 48203-1249
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Country | US
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Telephone | 586-980-0090
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Fax | 586-980-0090
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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 | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State | MI
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