Healthcare Provider Details

I. General information

NPI: 1033732789
Provider Name (Legal Business Name): JENNIFER FELECIA SYKES CPSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2020
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3426 MACK AVE
DETROIT MI
48207-2315
US

IV. Provider business mailing address

8726 WOODWARD AVE
DETROIT MI
48202-2135
US

V. Phone/Fax

Practice location:
  • Phone: 313-832-3100
  • Fax: 313-692-4095
Mailing address:
  • Phone: 313-833-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: