Provider Demographics
NPI:1518761709
Name:BYRUM, SHANNON VICTORIA
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:VICTORIA
Last Name:BYRUM
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13995 FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-7222
Mailing Address - Country:US
Mailing Address - Phone:810-279-0425
Mailing Address - Fax:
Practice Address - Street 1:13995 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-7222
Practice Address - Country:US
Practice Address - Phone:810-279-0425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-04
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician