Healthcare Provider Details

I. General information

NPI: 1164816484
Provider Name (Legal Business Name): SYLVIA WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2015
Last Update Date: 03/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47100 SCHOENHERR RD. SUITE D
SHELBY TOWNSHIP MI
48315
US

IV. Provider business mailing address

47100 SCHOENHERR RD. SUITE D
SHELBY TOWNSHIP MI
48315
US

V. Phone/Fax

Practice location:
  • Phone: 586-685-0505
  • Fax: 586-685-0501
Mailing address:
  • Phone: 586-685-0505
  • Fax: 586-685-0501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number6802064809
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: