Provider Demographics
NPI:1255549937
Name:KONCHEL, SHELLY ANN
Entity type:Individual
Prefix:MISS
First Name:SHELLY
Middle Name:ANN
Last Name:KONCHEL
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 1:23412 TUCK RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-3467
Mailing Address - Country:US
Mailing Address - Phone:248-426-8228
Mailing Address - Fax:
Practice Address - Street 1:22433 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-3743
Practice Address - Country:US
Practice Address - Phone:248-476-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist