Basic Information
| Provider Information | |||||||||
| NPI: | 1275274433 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAWYER | ||||||||
| FirstName: | SHAWN | ||||||||
| MiddleName: | LATRICE | ||||||||
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| Mailing Information | |||||||||
| Address1: | TEAM WELLNESS CENTER | ||||||||
| Address2: | 2925 RUSSELL STREET | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482073976 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3133965300 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2925 RUSSELL ST | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482074825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3133965300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2022 | ||||||||
| LastUpdateDate: | 04/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | MI | Y | Agencies | Case Management |
No ID Information.