Healthcare Provider Details

I. General information

NPI: 1316100217
Provider Name (Legal Business Name): SHEELA MADIPELLI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 11/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41400 DEQUINDRE RD SUITE 121
STERLING HEIGHTS MI
48314-3763
US

IV. Provider business mailing address

41400 DEQUINDRE RD SUITE 121
STERLING HEIGHTS MI
48314-3763
US

V. Phone/Fax

Practice location:
  • Phone: 734-218-6980
  • Fax:
Mailing address:
  • Phone: 734-218-6980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301092508
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: