Healthcare Provider Details

I. General information

NPI: 1225950637
Provider Name (Legal Business Name): AMANDA SHERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 CHARLOTTE ST APT 45
DETROIT MI
48201-2733
US

IV. Provider business mailing address

14 CHARLOTTE ST APT 45
DETROIT MI
48201-2733
US

V. Phone/Fax

Practice location:
  • Phone: 248-736-5414
  • Fax:
Mailing address:
  • Phone: 248-736-5414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number86376
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: