Healthcare Provider Details

I. General information

NPI: 1194717280
Provider Name (Legal Business Name): SHELI L TINKELMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 06/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

197 LOUDON RD STE 350
CONCORD NH
03301
US

IV. Provider business mailing address

31420 NORTHWESTERN HWY SUITE 150
FARMINGTON HILLS MI
48334-2508
US

V. Phone/Fax

Practice location:
  • Phone: 978-691-5690
  • Fax: 978-691-5693
Mailing address:
  • Phone: 248-538-0109
  • Fax: 248-538-0675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601003149
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1351
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: