Healthcare Provider Details

I. General information

NPI: 1831675008
Provider Name (Legal Business Name): TIFFANY MAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2018
Last Update Date: 02/17/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11575 E LAKETOWNE DR
ALBERTVILLE MN
55301-4348
US

IV. Provider business mailing address

27777 INKSTER RD STE 100
FARMINGTON HILLS MI
48334-5312
US

V. Phone/Fax

Practice location:
  • Phone: 248-299-0030
  • Fax:
Mailing address:
  • Phone:
  • Fax: 615-577-5661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-18-30649
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: