Healthcare Provider Details

I. General information

NPI: 1033954094
Provider Name (Legal Business Name): SANDY ALLER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2024
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E LONG LAKE RD
TROY MI
48085-5524
US

IV. Provider business mailing address

115 E LONG LAKE RD
TROY MI
48085-5524
US

V. Phone/Fax

Practice location:
  • Phone: 248-828-7500
  • Fax: 248-813-6518
Mailing address:
  • Phone: 248-828-7500
  • Fax: 248-813-6518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number2024054529
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704370034
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704370034
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: