MEDICARE: SHAQUELLE LYNK BS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide	MI11012023839855	MI

General Provider Information

NPI Number	:	1093569493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAQUELLE LYNK BS

Provider Business Mailing Address
First Line	:	8260 E HOLLYWOOD ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48234-3899
Country	:	US
Telephone Number	:	313-649-0519
Fax Number	:

Provider Business Practice Location Address
First Line	:	8260 E HOLLYWOOD ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48234-3899
Country	:	US
Telephone Number	:	313-649-0519
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2024
Last Update Date	:	06/19/2024

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Directions to “ SHAQUELLE LYNK BS” Practice Location

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