Individual
PRINCE TYRO SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9315 TELEGRAPH RD, REDFORD, MI 48239-1260
(248) 513-5760
Mailing address
9315 TELEGRAPH RD, REDFORD, MI 48239-1260
(248) 513-5760
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
175T00000X-PEER
MI
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
175T00000X-PEER
—
MI
Enumeration date
04/24/2019
Last updated
05/05/2026
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