Provider Demographics
NPI:1669353785
Name:HARRIS, SHATORI DANIELLE
Entity type:Individual
Prefix:
First Name:SHATORI
Middle Name:DANIELLE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHATORI
Other - Middle Name:DANIELLE
Other - Last Name:BLANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:612 LUTHER AVE
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-2531
Mailing Address - Country:US
Mailing Address - Phone:337-302-8868
Mailing Address - Fax:
Practice Address - Street 1:612 LUTHER AVE
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-2531
Practice Address - Country:US
Practice Address - Phone:337-302-8868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula