Shantique Dortch

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

4703117952 Issued in MI

Practice address

39449 Della Rosa Dr
Sterling Heights, MI 48313-5227

Phone

(313) 870-8736

NPI assigned

Jul 12, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lurranah Safe Haven LLC

  • Home Health Agency
  • Sterling Heights, MI
  • NPI 1487341459
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1531353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649894400000",
    "number": "1144706169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39449 DELLA ROSA DR",
            "city": "STERLING HEIGHTS",
            "state": "MI",
            "postal_code": "483135227",
            "telephone_number": "313-870-8736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39449 DELLA ROSA DR",
            "city": "STERLING HEIGHTS",
            "state": "MI",
            "postal_code": "483135227",
            "telephone_number": "313-870-8736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DORTCH",
        "first_name": "SHANTIQUE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-07-12",
        "last_updated": "2022-04-14",
        "certification_date": "2022-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "MI",
            "license": "4703117952",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Armani Donald
• Janet M Doody, O.T.R.
• Elise M Doppel, MPH. CCRC, FNTP, RWP
• Kimberly Marie Dorband, LPTA
• Gabrielle Dorchak
• Apurva N Doshi, BS PHARMACY
• Shelley Doshi
• Douglas J Kardynal PC
• Douglas W. Koenke, D.D.S.
• Jessica Dowda, MD

• Licensed Practical Nurse in Sterling Heights, MI
• Providers in Sterling Heights, MI by specialty
• Licensed Practical Nurse in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.