Provider Demographics
NPI:1497787576
Name:BINKLEY, SHELLEY SUE (MD)
Entity Type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:SUE
Last Name:BINKLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:SUE
Other - Last Name:BINKLEY-CREW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4936 FAIRWAY RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-3320
Mailing Address - Country:US
Mailing Address - Phone:248-494-0543
Mailing Address - Fax:
Practice Address - Street 1:4936 FAIRWAY RIDGE CIR
Practice Address - Street 2:SUITE 200
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-3320
Practice Address - Country:US
Practice Address - Phone:248-494-0543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7426123-1205207V00000X
WAMD61255120208M00000X, 207V00000X
MI4301101871207V00000X
CO33235207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01332352Medicaid
G35046Medicare UPIN
802741Medicare ID - Type Unspecified
CO01332352Medicaid