Healthcare Provider Details

I. General information

NPI: 1770546749
Provider Name (Legal Business Name): AMBER LYNN SHULL PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 W SEAWAY DR
NORTON SHORES MI
49444-3759
US

IV. Provider business mailing address

131 W SEAWAY DR STE 200
NORTON SHORES MI
49444-3761
US

V. Phone/Fax

Practice location:
  • Phone: 231-375-8065
  • Fax: 231-375-8076
Mailing address:
  • Phone: 231-375-8065
  • Fax: 231-375-8063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601003325
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: