Healthcare Provider Details

I. General information

NPI: 1871422410
Provider Name (Legal Business Name): ALEXANDRA SHULICK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 S PONTIAC TRL
WALLED LAKE MI
48390-3351
US

IV. Provider business mailing address

212 S PONTIAC TRL
WALLED LAKE MI
48390-3351
US

V. Phone/Fax

Practice location:
  • Phone: 248-854-8270
  • Fax:
Mailing address:
  • Phone: 248-854-8270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: