Shawna Davella Dietrick

Primary specialty

Child Physical Disabilities Respite CareTaxonomy code 385HR2065X

License

D362765135841 Issued in MI

Practice address

35675 Garner St
Romulus, MI 48174-4129

Phone

(810) 308-7991

NPI assigned

Feb 27, 2020

Last updated

Feb 27, 2020By the provider in NPPES

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

Other identifiers 1

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Gracious by Your Side LLC

  • Community/Behavioral Health Agency
  • Romulus, MI
  • NPI 1346996287
  NPD Authorized official
• Gracious by Your Side LLC

  • Community/Behavioral Health Agency
  • Romulus, MI
  • NPI 1194634519
  NPD (past) Authorized official

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

{
    "created_epoch": "1582761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582761600000",
    "number": "1154955219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 74083",
            "city": "ROMULUS",
            "state": "MI",
            "postal_code": "481740083",
            "telephone_number": "810-308-7991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35675 GARNER ST",
            "city": "ROMULUS",
            "state": "MI",
            "postal_code": "481744129",
            "telephone_number": "810-308-7991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIETRICK",
        "first_name": "SHAWNA",
        "middle_name": "DAVELLA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-02-27",
        "last_updated": "2020-02-27",
        "certification_date": "2020-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "385HR2065X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Physical Disabilities, Child",
            "state": "MI",
            "license": "D362765135841",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IDENTIFICATION",
            "identifier": "D362765135841",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michelle M Davis
• Tajzha Davis
• Trinilda Feleir Dearing, MA, TLLP
• Gregory Lynn Delaney, RSW
• Destiny Air, LLC
• Direct Health Solutions Inc
• Breona Symone Dixon, RN
• Jon Paul Doman, R.PH.
• Latice Drakeford
• Dva Renal Healthcare Inc (Romulus Dialysis)

• Respite Care in Romulus, MI
• Providers in Romulus, MI by specialty
• Respite Care in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2020; 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.