Provider Demographics
NPI:1548648587
Name:YARLAGADDA, SUSHMA (PA)
Entity type:Individual
Prefix:
First Name:SUSHMA
Middle Name:
Last Name:YARLAGADDA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5823 MIDDLEBELT RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-2459
Mailing Address - Country:US
Mailing Address - Phone:734-421-6333
Mailing Address - Fax:734-421-9954
Practice Address - Street 1:5823 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2459
Practice Address - Country:US
Practice Address - Phone:734-421-6333
Practice Address - Fax:734-421-9954
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601007256363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant