Provider Demographics
NPI:1861675704
Name:SAKALIAN, KELLY MICHELLE (RN, NP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:MICHELLE
Last Name:SAKALIAN
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:30055 NORTHWESTERN HWY STE L-30
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3211
Mailing Address - Country:US
Mailing Address - Phone:248-865-4238
Mailing Address - Fax:248-865-4237
Practice Address - Street 1:30055 NORTHWESTERN HWY STE L-30
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334
Practice Address - Country:US
Practice Address - Phone:248-865-4238
Practice Address - Fax:248-865-4237
Is Sole Proprietor?:No
Enumeration Date:2007-12-14
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI47041949510163WX0200X
MI4704149510363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WX0200XNursing Service ProvidersRegistered NurseOncology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner