Healthcare Provider Details

I. General information

NPI: 1962328633
Provider Name (Legal Business Name): SARAH ROSE SUDBAY DNP, AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11129 SANDY CREEK DR
SOUTH LYON MI
48178-8822
US

IV. Provider business mailing address

11129 SANDY CREEK DR
SOUTH LYON MI
48178-8822
US

V. Phone/Fax

Practice location:
  • Phone: 248-514-4657
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number4704349500
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: