Healthcare Provider Details

I. General information

NPI: 1568104016
Provider Name (Legal Business Name): SABRINA SRBU PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2122 HEALTH DR SW STE 160
WYOMING MI
49519-9402
US

IV. Provider business mailing address

16185 VIA MERA
MACOMB MI
48042-1036
US

V. Phone/Fax

Practice location:
  • Phone: 616-252-4302
  • Fax:
Mailing address:
  • Phone: 586-457-0331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: