Individual provider Active NPI

Sharanya Bamzai

  • Pediatrics Physician
  • Canton, MI
National Provider Identifier
1629694088
Registry record updated Aug 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
4301514136 Issued in MI
Practice address
1051 N Canton Center Rd
Canton, MI 48187-5097
Phone
(734) 539-5080
NPI assigned
Jun 22, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 4351049380 MI
Student in an Organized Health Care Education/Training Program 390200000X
Pediatrics Physician 208000000X 4301514136 MI Primary

Addresses

Primary practice location

1051 N Canton Center Rd
Canton, MI 48187-5097

Mailing address

1540 E Hospital Dr
Ann Arbor, MI 48109-4000
Phone (734) 647-1774

Other practice location 1

22101 Moross Rd
Detroit, MI 48236-2148
Phone (313) 343-4000

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20250619001560 MI Practitioner - Pediatric Medicine 3072992643 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301514136MIMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Health St. John Hospital Pediatrics CurrentSince Jul 1, 2025 Accepting new patients
Henry Ford Health St. John Hospital CurrentSince Jul 1, 2025 Accepting new patients
Henry Ford Health St. John Hospital Current Accepting new patients

Locations

22101 Moross Rd
Detroit, MI 48236
Phone (313) 343-3248

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1592784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754956800000",
    "number": "1629694088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1540 E HOSPITAL DR",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481094000",
            "telephone_number": "734-647-1774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1051 N CANTON CENTER RD",
            "city": "CANTON",
            "state": "MI",
            "postal_code": "481875097",
            "telephone_number": "734-539-5080"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "22101 Moross Rd",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482362148",
            "country_code": "US",
            "telephone_number": "313-343-4000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BAMZAI",
        "first_name": "SHARANYA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-22",
        "last_updated": "2025-08-12",
        "certification_date": "2025-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MI",
            "license": "4351049380",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301514136",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, MI

Sources for this page

Verify at the official NPI Registry.