Healthcare Provider Details

I. General information

NPI: 1508956426
Provider Name (Legal Business Name): SOBHA VAKHARIYA PSYD, LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SOBHA VALLABHANENI

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22255 GREENFIELD RD # 132
SOUTHFIELD MI
48075-3710
US

IV. Provider business mailing address

28000 DEQUINDRE RD
WARREN MI
48092-2468
US

V. Phone/Fax

Practice location:
  • Phone: 248-849-3301
  • Fax: 248-849-5349
Mailing address:
  • Phone: 586-753-0405
  • Fax: 586-753-0404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301013117
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: