Healthcare Provider Details

I. General information

NPI: 1750856480
Provider Name (Legal Business Name): ZACHARY WILLIAM SALAYSAY NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2018
Last Update Date: 10/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 WALTON BLVD STE 200
ROCHESTER HILLS MI
48309-1779
US

IV. Provider business mailing address

1460 WALTON BLVD STE 200
ROCHESTER HILLS MI
48309-1779
US

V. Phone/Fax

Practice location:
  • Phone: 248-650-1800
  • Fax: 248-650-1856
Mailing address:
  • Phone: 248-650-1800
  • Fax: 248-650-1856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704314282
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: