Active NPI
Prince Tyro Shannon
- Case Manager/Care Coordinator
- Redford, MI
National Provider Identifier
1467016584
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- License
- 175T00000X-PEER
- Practice address
- 9315 Telegraph Rd
Redford, MI 48239-1260 - Phone
- (248) 513-5760
- NPI assigned
- Apr 24, 2019
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | 175T00000X-PEER | MI | Primary |
Addresses
Primary practice location
9315 Telegraph Rd
Redford, MI 48239-1260
Mailing address
9315 Telegraph Rd
Redford, MI 48239-1260
Phone (248) 513-5760
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 175T00000X-PEER | Medicaid | MI |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 175T00000X-PEER | MI | MD | Case Manager/Care Coordinator |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1556064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1777939200000",
"number": "1467016584",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9315 TELEGRAPH RD",
"city": "REDFORD",
"state": "MI",
"postal_code": "482391260",
"telephone_number": "248-513-5760"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9315 TELEGRAPH RD",
"city": "REDFORD",
"state": "MI",
"postal_code": "482391260",
"telephone_number": "248-513-5760"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHANNON",
"first_name": "PRINCE",
"middle_name": "TYRO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-04-24",
"last_updated": "2026-05-05",
"certification_date": "2026-05-05",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": "MI",
"license": "175T00000X-PEER",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "175T00000X-PEER",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Redford, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.