Healthcare Provider Details

I. General information

NPI: 1699679464
Provider Name (Legal Business Name): FALLON SHERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26524 JOHN R RD
MADISON HEIGHTS MI
48071-3612
US

IV. Provider business mailing address

1240 ELAINE DR
TROY MI
48083-2106
US

V. Phone/Fax

Practice location:
  • Phone: 313-283-2749
  • Fax:
Mailing address:
  • Phone: 313-283-2749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6851115532
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: