Healthcare Provider Details

I. General information

NPI: 1457883274
Provider Name (Legal Business Name): JACQUIS LESHAY GRAY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACQUIS LESHAY HOOD PA-C

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 E 9 MILE RD
FERNDALE MI
48220-1934
US

IV. Provider business mailing address

18000 W 9 MILE RD STE 200
SOUTHFIELD MI
48075-4020
US

V. Phone/Fax

Practice location:
  • Phone: 248-336-4000
  • Fax:
Mailing address:
  • Phone: 248-336-4000
  • Fax: 248-336-9137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601008149
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: