Healthcare Provider Details

I. General information

NPI: 1831068220
Provider Name (Legal Business Name): VICTORIA MATOVSKI
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2025
Last Update Date: 06/07/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54195 CAMBRIDGE DR
SHELBY TOWNSHIP MI
48315-1669
US

IV. Provider business mailing address

54195 CAMBRIDGE DR
SHELBY TOWNSHIP MI
48315-1669
US

V. Phone/Fax

Practice location:
  • Phone: 586-404-1968
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704390207
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: