Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist |
NPI | 1285229708 |
---|---|
Provider Name | Shayleen Katrina Smith |
First Address | Shelby Township, MI 48317-1347 |
Second Address | Shelby Township, MI 48317-1347 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2021 |
Last Update Date | 01/11/2021 |