Healthcare Provider Details

I. General information

NPI: 1619807294
Provider Name (Legal Business Name): JEWELLA TAYLOR CENA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2026
Last Update Date: 05/23/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39500 WARREN RD TRLR 203
CANTON MI
48187-4378
US

IV. Provider business mailing address

39500 WARREN RD TRLR 203
CANTON MI
48187-4378
US

V. Phone/Fax

Practice location:
  • Phone: 734-258-4244
  • Fax:
Mailing address:
  • Phone: 734-258-4244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: