Healthcare Provider Details

I. General information

NPI: 1063325520
Provider Name (Legal Business Name): SHELBY VANKUIKEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

870 E SUPERIOR ST
WAYLAND MI
49348-9141
US

IV. Provider business mailing address

10009 DEER SIGHT DR
MIDDLEVILLE MI
49333-8006
US

V. Phone/Fax

Practice location:
  • Phone: 269-792-2254
  • Fax:
Mailing address:
  • Phone: 616-633-9352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: