Healthcare Provider Details

I. General information

NPI: 1073299467
Provider Name (Legal Business Name): SAMANTHA KAYANI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2023
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date: 08/18/2025
Reactivation Date: 08/26/2026

III. Provider practice location address

5770 HIGHLAND RD
WATERFORD MI
48327-1877
US

IV. Provider business mailing address

PO BOX 842
TROY MI
48099-0842
US

V. Phone/Fax

Practice location:
  • Phone: 248-301-1080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6852093689
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: