Healthcare Provider Details

I. General information

NPI: 1033524764
Provider Name (Legal Business Name): DANIEL SHELDEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2014
Last Update Date: 01/26/2023
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23715 LITTLE MACK AVE STE 100
SAINT CLAIR SHORES MI
48080-1181
US

IV. Provider business mailing address

26901 BEAUMONT BLVD STE 3D
SOUTHFIELD MI
48033-3849
US

V. Phone/Fax

Practice location:
  • Phone: 586-447-8021
  • Fax: 586-447-8022
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5101021375
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number5101021375
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: