Healthcare Provider Details

I. General information

NPI: 1104669522
Provider Name (Legal Business Name): LANESHA MAYE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2024
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 E 10 MILE RD
CENTER LINE MI
48015-1168
US

IV. Provider business mailing address

6900 E 10 MILE RD
CENTER LINE MI
48015-1168
US

V. Phone/Fax

Practice location:
  • Phone: 586-501-3070
  • Fax:
Mailing address:
  • Phone: 586-501-3070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: