Shobana Sundaram, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

4301077847 Issued in MI

Practice address

43184 Dequindre Rd
Ste 208
Sterling Heights, MI 48314

Phone

(586) 731-1500

Fax

(586) 731-1363

NPI assigned

Jul 3, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 7

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Pediatric and Adolescent Care Associates, PC

  • Pediatrics Physician
  • Sterling Heights, MI
  • NPI 1689012601
  NPD (past) Authorized official

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484697600000",
    "number": "1932138583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43184 DEQUINDRE RD",
            "address_2": "STE 208",
            "city": "STERLING HEIGHTS",
            "state": "MI",
            "postal_code": "48314",
            "telephone_number": "586-731-1500",
            "fax_number": "586-731-1363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43184 DEQUINDRE RD",
            "address_2": "STE 208",
            "city": "STERLING HEIGHTS",
            "state": "MI",
            "postal_code": "48314",
            "telephone_number": "586-731-1500",
            "fax_number": "586-731-1363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUNDARAM",
        "first_name": "SHOBANA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-03",
        "last_updated": "2017-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301077847",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPLUS COMMERCIAL",
            "identifier": "01004032",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCLAREN HEALTH PLAN",
            "identifier": "1010590",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "3502911592",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4711851-10",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4558267-10",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHP COMMERCIAL",
            "identifier": "200000005894",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCLAREN HEALTH PLAN",
            "identifier": "1010591",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Randi Jamal Sulaiman, LLMSW
• Melissa Jane Sullivan, CCC-SLP
• Tania Sultana
• Preslee Sultes
• Katherine M Summers, PTA
• Kyle Wayne Sundblad, DPM
• Sundus Marogy DDS PLLC
• Sundus Marogy Hy LLC
• Sunrise Behavioral Health Service LLC
• Sunrise Chiropractic PLLC

• Pediatrics Physician in Sterling Heights, MI
• Providers in Sterling Heights, MI by specialty
• Pediatrics Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.