Healthcare Provider Details

I. General information

NPI: 1689612764
Provider Name (Legal Business Name): SHARADA S HULBANNI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 02/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HURON VALLEY SINAI HOSPITAL PATHOLOGY 1 WILLIAM CARLS DR
COMMERCE TOWNSHIP MI
48382-1271
US

IV. Provider business mailing address

1560 E MAPLE RD SUITE 400-CREDENTIALING
TROY MI
48083-1189
US

V. Phone/Fax

Practice location:
  • Phone: 248-937-3435
  • Fax:
Mailing address:
  • Phone: 248-581-5974
  • Fax: 248-581-5640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number4301036255
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: