Provider Demographics
NPI:1417732678
Name:WIELFAERT, SHELBI R
Entity Type:Individual
Prefix:
First Name:SHELBI
Middle Name:R
Last Name:WIELFAERT
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 1:2838 OAK GROVE PL
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43613-3353
Mailing Address - Country:US
Mailing Address - Phone:419-705-9080
Mailing Address - Fax:
Practice Address - Street 1:15502 S TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-5520
Practice Address - Country:US
Practice Address - Phone:248-846-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician