Provider Demographics
NPI:1114443645
Name:HORANEY, SHELBEY LESLIE (CPHT)
Entity type:Individual
Prefix:
First Name:SHELBEY
Middle Name:LESLIE
Last Name:HORANEY
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2380 VALLEYWOOD DR SE APT S9
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-7714
Mailing Address - Country:US
Mailing Address - Phone:616-558-1322
Mailing Address - Fax:
Practice Address - Street 1:2727 WALKER AVE NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49544-1307
Practice Address - Country:US
Practice Address - Phone:616-558-1322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X
MI5303045419183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant