Provider Demographics
NPI:1144478207
Name:MALHOTRA, SUPARNA SHETTY (AUD)
Entity type:Individual
Prefix:
First Name:SUPARNA
Middle Name:SHETTY
Last Name:MALHOTRA
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 E MEDICAL CENTER DR
Mailing Address - Street 2:1904 TAUBMAN CENTER
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-5000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1500 E MEDICAL CENTER DR SPC 5312
Practice Address - Street 2:1904 TAUBMAN CENTER
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-5312
Practice Address - Country:US
Practice Address - Phone:734-936-7507
Practice Address - Fax:734-763-4006
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000204231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist