Provider Demographics
NPI:1932559796
Name:FELLOWS, SUZANNE BERRI (PA-C, NBC-HWC)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:BERRI
Last Name:FELLOWS
Suffix:
Gender:F
Credentials:PA-C, NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 LAKEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48302-2704
Mailing Address - Country:US
Mailing Address - Phone:248-535-3112
Mailing Address - Fax:
Practice Address - Street 1:1525 LAKEWOOD RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48302-2704
Practice Address - Country:US
Practice Address - Phone:248-535-3112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-13
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002568363A00000X
171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant