Individual
SHANTAYA MCDANIEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Contact information
Practice address
4866 BROOMFIELD WAY, ORION, MI 48359-1957
(248) 221-9638
Mailing address
4866 BROOMFIELD WAY, ORION, MI 48359-1957
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703130918
MI
Other
Enumeration date
12/09/2025
Last updated
12/09/2025
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