Provider Demographics
NPI:1538734611
Name:MEGHASHYAM, SUSHMITHA (MD)
Entity type:Individual
Prefix:MS
First Name:SUSHMITHA
Middle Name:
Last Name:MEGHASHYAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DMC, GME OFFICE 4201 ST. ANTOINE
Mailing Address - Street 2:UHC- 9C
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201
Mailing Address - Country:US
Mailing Address - Phone:313-745-5146
Mailing Address - Fax:313-966-0880
Practice Address - Street 1:CHILDREN'S HOSPITAL MICHIGAN
Practice Address - Street 2:3901 BEAUBIEN STREET
Practice Address - City:DETRIOT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-745-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program