Shantaya McDaniel

Individual provider Active NPI Licensed Practical Nurse · Orion, MI

NPI 1700749306 · NPPES record last updated Dec 9, 2025

Key facts

NPI
1700749306
Entity type
Individual (NPI type 1)
Primary specialty
Licensed Practical Nurse 164W00000X
License
4703130918 (MI)
Practice address
4866 Broomfield Way
Orion, MI 48359-1957
Phone
(248) 221-9638
NPI assigned
Dec 9, 2025
Sex
Unspecified or another gender identity
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
4703130918MIMDLicensed Practical Nurse

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 4703130918 MI Yes

Addresses

Primary practice location

4866 Broomfield Way
Orion, MI 48359-1957

Mailing address

4866 Broomfield Way
Orion, MI 48359-1957

Other providers in Orion, MI

All providers in Orion, MI · Licensed Practical Nurse in Michigan

Sources for this page

Verify at the official NPI Registry.