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NPI Code Detail

MEDICARE: SHAWTA REED

MEDICARE: SHAWTA REED
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
1106S00000XBehavior TechnicianMI
2374U00000XHome Health Aide
3106S00000XBehavior Technician

General Provider Information

NPI Number : 1275916199
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAWTA REED
Provider Business Mailing Address
First Line : 13044 KILBOURNE ST
Second Line :
City : DETROIT
State : MI
Zip : 48213-1412
Country : US
Telephone Number : 734-643-8338
Fax Number :
Provider Business Practice Location Address
First Line : 3290 W BIG BEAVER RD STE 510
Second Line :
City : TROY
State : MI
Zip : 48084-2917
Country : US
Telephone Number : 734-513-2731
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/09/2015
Last Update Date : 12/13/2024

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Directions to “ SHAWTA REED ” Practice Location

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