Healthcare Provider Details

I. General information

NPI: 1730091075
Provider Name (Legal Business Name): SAILESH RAM YELLAYI MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

5777 W MAPLE RD
WEST BLOOMFIELD MI
48322-2267
US

IV. Provider business mailing address

30865 BRUCE LN
FRANKLIN MI
48025-1559
US

V. Phone/Fax

Practice location:
  • Phone: 248-767-7927
  • Fax: 248-624-3279
Mailing address:
  • Phone: 248-933-7559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6362010463
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: