| Doctor Name: | SHELLEY GALASSO BONANNO |
| NPI Number: | 1053411785 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA LLP |
| License Number: | 6301006934 |
| Business Practice Address: | 36975 Utica Road Suite 104 Clinton Township, MI - 48036 |
| Business Phone Number: | 5862263440 |
| Business Fax Number: | 5862263740 |
| Mailing Address: | 36975 Utica Road, Suite 103 CLINTON TOWNSHIP |
| State: | MI |
| Postal Code: | 48036 |
| Phone Number: | 5862263440 |
| Fax Number: | 5862263672 |
| NPI Enumeration Date: | 09/23/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 6301006934 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |