Healthcare Provider Details

I. General information

NPI: 1205576618
Provider Name (Legal Business Name): SHELBI DALE DIAMOND SST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. SHELBI DALE DYKE

II. Dates (important events)

Enumeration Date: 04/01/2022
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11652 W GRAND RIVER AVE
LOWELL MI
49331-8465
US

IV. Provider business mailing address

315 N JACKSON ST
LOWELL MI
49331-1425
US

V. Phone/Fax

Practice location:
  • Phone: 616-248-5166
  • Fax:
Mailing address:
  • Phone: 616-844-8965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: