Healthcare Provider Details

I. General information

NPI: 1205486065
Provider Name (Legal Business Name): MS. DALIEA SHANTIQUA LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2019
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39650 ORCHARD HILL PL STE 200
NOVI MI
48375-5392
US

IV. Provider business mailing address

27400 FRANKLIN RD APT 511
SOUTHFIELD MI
48034-2316
US

V. Phone/Fax

Practice location:
  • Phone: 248-938-4106
  • Fax:
Mailing address:
  • Phone: 313-335-4722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number12689505
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: