Provider Demographics
NPI:1518290337
Name:BORRELLI, ELENA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ELENA
Middle Name:
Last Name:BORRELLI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ELENA
Other - Middle Name:
Other - Last Name:AMATO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13719 23 MILE RD
Mailing Address - Street 2:STE 146
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-2907
Mailing Address - Country:US
Mailing Address - Phone:586-212-6915
Mailing Address - Fax:
Practice Address - Street 1:13719 23 MILE RD # 146
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-2907
Practice Address - Country:US
Practice Address - Phone:248-266-1355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-11
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005627363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI12024128OtherCAQH