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NPI Code Detail

MEDICARE: SHANITA WADE

MEDICARE: SHANITA WADE
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
1101Y00000XCounselor6401017983MI

General Provider Information

NPI Number : 1265737951
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANITA WADE
Provider Business Mailing Address
First Line : PO BOX 10
Second Line :
City : MASON
State : MI
Zip : 48854-0010
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 411 W LAKE LANSING RD STE A100
Second Line :
City : EAST LANSING
State : MI
Zip : 48823-8404
Country : US
Telephone Number : 517-798-3717
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/11/2011
Last Update Date : 03/29/2023

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Directions to “ SHANITA WADE ” Practice Location

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