MEDICARE: SHYANNE MURRAY LLMSW

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	104100000X	Social Worker	6851119864	MI

General Provider Information

NPI Number	:	1538959390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHYANNE MURRAY LLMSW

Provider Business Mailing Address
First Line	:	557 GLENWOOD AVE SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49506-2702
Country	:	US
Telephone Number	:	810-701-1540
Fax Number	:

Provider Business Practice Location Address
First Line	:	557 GLENWOOD AVE SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49506-2702
Country	:	US
Telephone Number	:	810-701-1540
Fax Number	:

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

Provider Enumeration Date	:	05/07/2025
Last Update Date	:	05/21/2025

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