Healthcare Provider Details

I. General information

NPI: 1245708320
Provider Name (Legal Business Name): AMY ZELIDMAN, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2018
Last Update Date: 11/10/2022
Certification Date: 11/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36500 W 12 MILE RD
FARMINGTON HILLS MI
48331-3169
US

IV. Provider business mailing address

36500 W 12 MILE RD
FARMINGTON HILLS MI
48331-3169
US

V. Phone/Fax

Practice location:
  • Phone: 248-514-5354
  • Fax:
Mailing address:
  • Phone: 248-514-5354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. AMY ZELIDMAN
Title or Position: FULLY LICENSED PSYCHOLOGIST/OWNER
Credential: PHD, LP
Phone: 248-514-5354