Active NPI
Shiyan Adore Shackleford
- Family Psychologist
- Detroit, MI
National Provider Identifier
1255185799
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Psychologist
- Practice address
- 40 Davenport St
Apt 511a
Detroit, MI 48201-2423 - Phone
- (586) 265-0618
- NPI assigned
- Apr 12, 2024
- Last updated
- Apr 12, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Psychologist | 103TF0000X | NU | Primary |
Addresses
Primary practice location
40 Davenport St
Apt 511a
Detroit, MI 48201-2423
Mailing address
40 Davenport St
Apt 511a
Detroit, MI 48201-2423
Phone (586) 265-0618
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1712880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1712880000000",
"number": "1255185799",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "40 DAVENPORT ST",
"address_2": "APT 511A",
"city": "DETROIT",
"state": "MI",
"postal_code": "482012423",
"telephone_number": "586-265-0618"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "40 DAVENPORT ST",
"address_2": "APT 511A",
"city": "DETROIT",
"state": "MI",
"postal_code": "482012423",
"telephone_number": "586-265-0618"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHACKLEFORD",
"first_name": "SHIYAN",
"middle_name": "ADORE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-04-12",
"last_updated": "2024-04-12",
"certification_date": "2024-04-12",
"status": "A"
},
"taxonomies": [
{
"code": "103TF0000X",
"taxonomy_group": "",
"desc": "Psychologist, Family",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.