Provider Demographics
NPI:1215699434
Name:SHEFFERLY, SOMMER ELYSE (PA-C)
Entity type:Individual
Prefix:
First Name:SOMMER
Middle Name:ELYSE
Last Name:SHEFFERLY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3280 KENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1133
Mailing Address - Country:US
Mailing Address - Phone:248-703-7980
Mailing Address - Fax:
Practice Address - Street 1:23700 ORCHARD LAKE RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-2559
Practice Address - Country:US
Practice Address - Phone:248-482-6222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601010854363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant