Provider Demographics
NPI:1871626341
Name:SEIGEL, SHELLEY SUE
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:SUE
Last Name:SEIGEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:YALE
Mailing Address - State:MI
Mailing Address - Zip Code:48097-3318
Mailing Address - Country:US
Mailing Address - Phone:810-387-2022
Mailing Address - Fax:810-387-2282
Practice Address - Street 1:102 S MAIN ST
Practice Address - Street 2:
Practice Address - City:YALE
Practice Address - State:MI
Practice Address - Zip Code:48097-3318
Practice Address - Country:US
Practice Address - Phone:810-387-2022
Practice Address - Fax:810-387-2282
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist