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NPI Code Detail

MEDICARE: SHANNON KELLEY

MEDICARE: SHANNON KELLEY
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
1251B00000XCase Management Agency
2373H00000XDay Training/Habilitation Specialist

General Provider Information

NPI Number : 1639537913
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON KELLEY
Provider Business Mailing Address
First Line : 3111 GRAND RIVER AVE
Second Line :
City : DETROIT
State : MI
Zip : 48208-2962
Country : US
Telephone Number : 313-557-8669
Fax Number :
Provider Business Practice Location Address
First Line : 3111 GRAND RIVER AVE
Second Line :
City : DETROIT
State : MI
Zip : 48208-2962
Country : US
Telephone Number : 313-557-8669
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2016
Last Update Date : 02/13/2025

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Directions to “ SHANNON KELLEY ” Practice Location

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