Provider Demographics
NPI:1144278680
Name:DEATON, SHELLY ANN (AUD)
Entity type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:ANN
Last Name:DEATON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:MRS
Other - First Name:SHELLY
Other - Middle Name:ANN
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1600 COMMERCE PARK DR STE 300
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-1620
Mailing Address - Country:US
Mailing Address - Phone:734-433-0699
Mailing Address - Fax:734-433-1307
Practice Address - Street 1:1600 COMMERCE PARK DR STE 300
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118
Practice Address - Country:US
Practice Address - Phone:734-433-0699
Practice Address - Fax:734-433-1307
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000303231H00000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4697583Medicaid
MI640003498OtherRR MEDICARE
MIM25090004Medicare ID - Type UnspecifiedWA FOOTE MEMORIAL