1356731509 NPI number — MS. SHAWNDREKA SHANAY PAYNE MA, LLPC

Table of content: MS. SHAWNDREKA SHANAY PAYNE MA, LLPC (NPI 1356731509)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356731509 NPI number — MS. SHAWNDREKA SHANAY PAYNE MA, LLPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAYNE
Provider First Name:
SHAWNDREKA
Provider Middle Name:
SHANAY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA, LLPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356731509
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
985 E BARNEY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MUSKEGON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49444-1708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-726-6860
Provider Business Mailing Address Fax Number:
231-722-5164

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
985 E BARNEY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MUSKEGON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49444-1708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-726-6860
Provider Business Practice Location Address Fax Number:
231-722-5164
Provider Enumeration Date:
01/27/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  6401014289 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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