Provider Demographics
NPI:1578568895
Name:NEPA, SHELLEY A (DO)
Entity Type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:A
Last Name:NEPA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 HAGGERTY RD STE 2130
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-2191
Mailing Address - Country:US
Mailing Address - Phone:248-669-2040
Mailing Address - Fax:248-669-2046
Practice Address - Street 1:2300 HAGGERTY RD STE 2130
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-2191
Practice Address - Country:US
Practice Address - Phone:248-669-2040
Practice Address - Fax:248-669-2046
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISN011994208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4274200Medicaid
G58369Medicare UPIN
ON24460Medicare ID - Type Unspecified