Healthcare Provider Details

I. General information

NPI: 1154207751
Provider Name (Legal Business Name): AMANDA SHEA DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2025
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 E EISENHOWER PKWY
ANN ARBOR MI
48108-3231
US

IV. Provider business mailing address

4500 SAINT ANTHONY RD
TEMPERANCE MI
48182-9779
US

V. Phone/Fax

Practice location:
  • Phone: 734-677-0070
  • Fax:
Mailing address:
  • Phone: 419-705-9825
  • Fax: 419-705-9825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704403629
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: