Individual
SHENICAK KUJUANA DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
16434 CONSTANCE AVE, DETROIT, MI 48228-4311
(313) 455-2910
Mailing address
16434 CONSTANCE AVE, DETROIT, MI 48228-4311
(313) 455-2910
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
106S00000X
Behavior Technician
—
MI
3747A0650X
Attendant Care Provider
Primary
—
MI
3747A0650X
Attendant Care Provider
—
—
3747P1801X
Personal Care Attendant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
82-4451938
CLS
MI
05
—
82-4451938
—
MI
01
—
824451938
MCPN'S
MI
01
—
824451938
DIFFERENT NETWORKS
—
05
—
844451938
—
MI
Enumeration date
02/27/2018
Last updated
12/12/2024
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