Healthcare Provider Details

I. General information

NPI: 1609689488
Provider Name (Legal Business Name): WAYNE COUNTY ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18900 EUREKA RD
SOUTHGATE MI
48195-2985
US

IV. Provider business mailing address

18900 EUREKA RD
SOUTHGATE MI
48195-2985
US

V. Phone/Fax

Practice location:
  • Phone: 734-624-3467
  • Fax:
Mailing address:
  • Phone: 734-624-3467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHALLU BHANOT
Title or Position: CEO
Credential:
Phone: 734-624-3467