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NPI Code Detail

MEDICARE: KAILI SHAYNE RODRIGUEZ

MEDICARE: KAILI SHAYNE RODRIGUEZ
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

General Provider Information

NPI Number : 1740106756
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAILI SHAYNE RODRIGUEZ
Provider Business Mailing Address
First Line : 603 EASTERN AVE NE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49503-1810
Country : US
Telephone Number : 616-942-2110
Fax Number :
Provider Business Practice Location Address
First Line : 3300 36TH ST SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49512-2810
Country : US
Telephone Number : 616-942-2110
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2026
Last Update Date : 06/24/2026

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Directions to “ KAILI SHAYNE RODRIGUEZ ” Practice Location

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