Healthcare Provider Details

I. General information

NPI: 1831079383
Provider Name (Legal Business Name): SHAQUAY SELBY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2025
Last Update Date: 09/05/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 W MICHIGAN AVE UNIT 224
JACKSON MI
49201-1302
US

IV. Provider business mailing address

156 W MICHIGAN AVE UNIT 224
JACKSON MI
49201-1302
US

V. Phone/Fax

Practice location:
  • Phone: 484-402-6529
  • Fax: 517-905-5912
Mailing address:
  • Phone: 484-402-6529
  • Fax: 517-905-5912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: