Active NPI
Marquisa Danae Shannon, B.A,M.B.A
- Other Technician
- Detroit, MI
National Provider Identifier
1568615888
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Other Technician
- License
- 6803085735
- Practice address
- 4875 Coplin St
Detroit, MI 48215-2192 - Phone
- (313) 822-1135
- Fax
- (313) 822-1157
- NPI assigned
- Oct 30, 2008
- 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 |
|---|---|---|---|---|
| Other Technician | 247200000X | 6803085735 | MI | Primary |
Addresses
Primary practice location
4875 Coplin St
Detroit, MI 48215-2192
Mailing address
274 Lakewood St
Detroit, MI 48215-3152
Phone (313) 822-7986
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
- Credentials
- Bachelor of Arts, Master of Business Administration
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6803085735 | MI | MD | Other Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1225324800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1225324800000",
"number": "1568615888",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "274 LAKEWOOD ST",
"city": "DETROIT",
"state": "MI",
"postal_code": "482153152",
"telephone_number": "313-822-7986"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4875 COPLIN ST",
"city": "DETROIT",
"state": "MI",
"postal_code": "482152192",
"telephone_number": "313-822-1135",
"fax_number": "313-822-1157"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHANNON",
"first_name": "MARQUISA",
"middle_name": "DANAE",
"name_prefix": "Ms.",
"credential": "B.A,M.B.A",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-10-30",
"last_updated": "2008-10-30",
"status": "A"
},
"taxonomies": [
{
"code": "247200000X",
"taxonomy_group": "",
"desc": "Technician, Other",
"state": "MI",
"license": "6803085735",
"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 Oct 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.