Healthcare Provider Details

I. General information

NPI: 1912824822
Provider Name (Legal Business Name): JACQUELINE SAFADI HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

45600 UTICA PARK BLVD
UTICA MI
48315-5917
US

IV. Provider business mailing address

45600 UTICA PARK BLVD
UTICA MI
48315-5917
US

V. Phone/Fax

Practice location:
  • Phone: 586-997-1219
  • Fax:
Mailing address:
  • Phone: 586-997-1219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number3502009949
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: