Healthcare Provider Details

I. General information

NPI: 1851149959
Provider Name (Legal Business Name): ALEXSIS SHEMKA CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2024
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44201 DEQUINDRE RD STE EC
TROY MI
48085-1117
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 248-259-3088
  • Fax: 248-964-6133
Mailing address:
  • Phone: 947-522-1848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number4704353053
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: