Healthcare Provider Details

I. General information

NPI: 1164353785
Provider Name (Legal Business Name): SHAVEENA SIVAPALAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 E MICHIGAN AVE
LANSING MI
48912-1811
US

IV. Provider business mailing address

4640 WIND RIDGE CT
ROCHESTER MI
48306-1646
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-1000
  • Fax:
Mailing address:
  • Phone: 248-990-6940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number5151018268
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: