Wardha Shabbir, MD

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

License

4301513354 Issued in MI

Practice address

205 N East Ave
Jackson, MI 49201-1753

Phone

(517) 205-4800

NPI assigned

Jul 8, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: wshabbir729699@direct.hfhs.org

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1625702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751328000000",
    "number": "1104497395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26750 PROVIDENCE PKWY STE 210",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483741212",
            "telephone_number": "248-465-4469",
            "fax_number": "248-465-4503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 N EAST AVE",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492011753",
            "telephone_number": "517-205-4800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHABBIR",
        "first_name": "WARDHA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-08",
        "last_updated": "2025-07-01",
        "certification_date": "2025-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "MI",
            "license": "4301513354",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MI",
            "license": "4351047565",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Philip Serino, O.D.
• David Scott Severance, DC
• Moriah K Severance, DC
• Misty Sewell
• Omar Suhail Shabandri, MD
• Husam Shadid, MD
• Scarlet Shaffer, MA, CCC-SLP
• Heather Shafley
• Bhavna Rajesh Shah, MD
• Rajesh Punjalal Shah, MD

• Sports Medicine (Family Medicine) Physician in Jackson, MI
• Providers in Jackson, MI by specialty
• Sports Medicine (Family Medicine) Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.