Healthcare Provider Details

I. General information

NPI: 1508726886
Provider Name (Legal Business Name): SAMANTHA MARIA SAYLES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 SAINT ANTOINE ST
DETROIT MI
48201-2153
US

IV. Provider business mailing address

21550 CARLTON DR
MACOMB MI
48044-1857
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-3000
  • Fax:
Mailing address:
  • Phone: 586-854-3932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704345880
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: