Provider Demographics
NPI:1881579019
Name:ROBERSON, JAYDON
Entity type:Individual
Prefix:
First Name:JAYDON
Middle Name:
Last Name:ROBERSON
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 FISCHER DR
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186-3467
Mailing Address - Country:US
Mailing Address - Phone:734-756-1412
Mailing Address - Fax:
Practice Address - Street 1:2146 MOELLER AVE
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-9237
Practice Address - Country:US
Practice Address - Phone:734-273-9194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker