Provider Demographics
NPI:1053156877
Name:BROYLES, CHRISTIN SHAVON (CPT)
Entity type:Individual
Prefix:MS
First Name:CHRISTIN
Middle Name:SHAVON
Last Name:BROYLES
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1965 DEVONSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0618
Mailing Address - Country:US
Mailing Address - Phone:313-530-4375
Mailing Address - Fax:
Practice Address - Street 1:1965 DEVONSHIRE RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0618
Practice Address - Country:US
Practice Address - Phone:313-530-4375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy