Provider Demographics
NPI:1194244129
Name:HENDERSON, SHAMEKA LATRICE
Entity type:Individual
Prefix:
First Name:SHAMEKA
Middle Name:LATRICE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1688 HOLLYWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1312
Mailing Address - Country:US
Mailing Address - Phone:313-457-9188
Mailing Address - Fax:
Practice Address - Street 1:1688 HOLLYWOOD AVE
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-1312
Practice Address - Country:US
Practice Address - Phone:313-457-9188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-11
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula