Provider Demographics
NPI:1316120744
Name:GROSS, SHAINA R
Entity type:Individual
Prefix:
First Name:SHAINA
Middle Name:R
Last Name:GROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SHAINA
Other - Middle Name:R
Other - Last Name:BURNS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5690 HARRIS RD
Mailing Address - Street 2:# 4
Mailing Address - City:GRANT TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48032-1811
Mailing Address - Country:US
Mailing Address - Phone:810-388-1200
Mailing Address - Fax:
Practice Address - Street 1:1600 GRATIOT BLVD
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:MI
Practice Address - Zip Code:48040-1145
Practice Address - Country:US
Practice Address - Phone:810-388-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant