Provider Demographics
NPI:1891588232
Name:HAYDEN, SHAFONTA
Entity type:Individual
Prefix:
First Name:SHAFONTA
Middle Name:
Last Name:HAYDEN
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 1:19959 RIOPELLE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48203-1249
Mailing Address - Country:US
Mailing Address - Phone:586-980-0090
Mailing Address - Fax:586-980-0090
Practice Address - Street 1:19959 RIOPELLE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48203-1249
Practice Address - Country:US
Practice Address - Phone:586-980-0090
Practice Address - Fax:586-980-0090
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X, 171M00000X, 347C00000X
MI172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171400000XOther Service ProvidersHealth & Wellness Coach
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No347C00000XTransportation ServicesPrivate Vehicle