Healthcare Provider Details

I. General information

NPI: 1821903758
Provider Name (Legal Business Name): TIFFANY SUELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13709 W 8 MILE RD
DETROIT MI
48235-1531
US

IV. Provider business mailing address

1672 ESTATES DR
DETROIT MI
48206-2820
US

V. Phone/Fax

Practice location:
  • Phone: 313-437-1073
  • Fax:
Mailing address:
  • Phone: 313-623-3821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: