Healthcare Provider Details

I. General information

NPI: 1972156966
Provider Name (Legal Business Name): SAIDY AMAL SALEM HERNANDEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2019
Last Update Date: 07/05/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 CHERRY ST SE STE 200
GRAND RAPIDS MI
49503-4607
US

IV. Provider business mailing address

496 CARR 112
ISABELA PR
00662-6043
US

V. Phone/Fax

Practice location:
  • Phone: 616-685-6330
  • Fax:
Mailing address:
  • Phone: 787-210-8035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number22539
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number22539
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number22539
License Number StatePR
# 4
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number4301517731
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: