Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 125060551 | IL |
Y | 2080P0201X | Pediatric Allergist | 4301113303 | MI |
NPI | 1972890028 |
---|---|
Provider Name | Sherlyana Surja |
First Address | Troy, MI 48098-2426 |
Second Address | Sterling Heights, MI 48314-1707 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2011 |
Last Update Date | 29/05/2020 |