Provider Demographics
NPI:1629931944
Name:GARRETT, SHAHITA
Entity type:Individual
Prefix:
First Name:SHAHITA
Middle Name:
Last Name:GARRETT
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 1:722 GLADSTONE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-1766
Mailing Address - Country:US
Mailing Address - Phone:313-204-2455
Mailing Address - Fax:
Practice Address - Street 1:509 CHANDLER ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2830
Practice Address - Country:US
Practice Address - Phone:313-204-2455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-12-04
Last Update Date:2025-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS820283655311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home