Provider Demographics
NPI:1205065182
Name:SLEBODNIK, SHARI (PHD, LLP)
Entity type:Individual
Prefix:DR
First Name:SHARI
Middle Name:
Last Name:SLEBODNIK
Suffix:
Gender:F
Credentials:PHD, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24674 BERRY AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48089-2132
Mailing Address - Country:US
Mailing Address - Phone:586-838-0825
Mailing Address - Fax:248-809-4134
Practice Address - Street 1:1700 W BIG BEAVER RD STE 200
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-3524
Practice Address - Country:US
Practice Address - Phone:586-838-0825
Practice Address - Fax:248-809-4134
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-13
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014402103TC0700X
MI6361005560103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical