Healthcare Provider Details

I. General information

NPI: 1952230112
Provider Name (Legal Business Name): SHELBY JANEWAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28098 23 MILE RD
CHESTERFIELD MI
48051-2316
US

IV. Provider business mailing address

28098 23 MILE RD
CHESTERFIELD MI
48051-2316
US

V. Phone/Fax

Practice location:
  • Phone: 586-949-0123
  • Fax: 586-228-9019
Mailing address:
  • Phone: 586-949-0123
  • Fax: 586-228-9019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: