MEDICARE: NEVAEH SKYE BULLITT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1629932512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEVAEH SKYE BULLITT

Provider Business Mailing Address
First Line	:	10201 E JEFFERSON AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48214-3149
Country	:	US
Telephone Number	:	313-446-8980
Fax Number	:

Provider Business Practice Location Address
First Line	:	10201 E JEFFERSON AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48214-3149
Country	:	US
Telephone Number	:	313-446-8980
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2025
Last Update Date	:	12/15/2025

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Directions to “ NEVAEH SKYE BULLITT ” Practice Location

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