Healthcare Provider Details

I. General information

NPI: 1659288835
Provider Name (Legal Business Name): SEQUOIA PARKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4410 W 13 MILE RD
ROYAL OAK MI
48073-6515
US

IV. Provider business mailing address

16621 BAYLIS ST
DETROIT MI
48221-3197
US

V. Phone/Fax

Practice location:
  • Phone: 248-549-4339
  • Fax:
Mailing address:
  • Phone: 248-993-3456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: