Healthcare Provider Details

I. General information

NPI: 1942110176
Provider Name (Legal Business Name): DELISA HAIR STUDIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 WASHTENAW AVE
ANN ARBOR MI
48104-5160
US

IV. Provider business mailing address

PO BOX 1177
BRIGHTON MI
48116-2777
US

V. Phone/Fax

Practice location:
  • Phone: 248-521-0655
  • Fax:
Mailing address:
  • Phone: 248-521-0655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State

VIII. Authorized Official

Name: DELISA SHEPHERD
Title or Position: COSMETOLOGIST
Credential: CPSPECIALIST
Phone: 248-521-0655