Healthcare Provider Details

I. General information

NPI: 1104637156
Provider Name (Legal Business Name): AYA BAYDOUN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2025
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13320 W WARREN AVE
DEARBORN MI
48126-1493
US

IV. Provider business mailing address

13320 W WARREN AVE
DEARBORN MI
48126-1493
US

V. Phone/Fax

Practice location:
  • Phone: 313-581-4450
  • Fax:
Mailing address:
  • Phone: 313-265-7226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704375872
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: