Healthcare Provider Details

I. General information

NPI: 1124506126
Provider Name (Legal Business Name): MR. SHELBY A LEVIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2018
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7270 N BRIARCLIFF KNOLL DR
WEST BLOOMFIELD MI
48322-4048
US

IV. Provider business mailing address

6689 ORCHARD LAKE RD STE 320
WEST BLOOMFIELD MI
48322-3404
US

V. Phone/Fax

Practice location:
  • Phone: 248-932-7799
  • Fax:
Mailing address:
  • Phone: 248-752-1724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801116580
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: