Provider Demographics
NPI:1306593959
Name:TATIGIAN, SHAE
Entity type:Individual
Prefix:
First Name:SHAE
Middle Name:
Last Name:TATIGIAN
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 1:942 CANTERBURY ST SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49509-2837
Mailing Address - Country:US
Mailing Address - Phone:248-756-0825
Mailing Address - Fax:
Practice Address - Street 1:3350 EAST PARIS AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49512-2907
Practice Address - Country:US
Practice Address - Phone:616-734-6094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician