Provider Demographics
NPI:1598930810
Name:SHEFSKY, MICHAEL W (PHD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:SHEFSKY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 REGENCY CT
Mailing Address - Street 2:SUITE L 103
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-6188
Mailing Address - Country:US
Mailing Address - Phone:262-789-7733
Mailing Address - Fax:
Practice Address - Street 1:220 REGENCY CT
Practice Address - Street 2:SUITE L 103
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-6188
Practice Address - Country:US
Practice Address - Phone:262-789-7733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071003314103TC0700X
WI1136057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39072300Medicaid
WI39072300Medicaid