Provider Demographics
NPI:1316220551
Name:SHENOY, SUJA S (MD)
Entity type:Individual
Prefix:DR
First Name:SUJA
Middle Name:S
Last Name:SHENOY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4401 CAMPUS RIDGE DR STE 1100
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-6125
Mailing Address - Country:US
Mailing Address - Phone:989-837-9200
Mailing Address - Fax:989-837-9205
Practice Address - Street 1:4401 CAMPUS RIDGE DR STE 1100
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-6125
Practice Address - Country:US
Practice Address - Phone:989-837-9200
Practice Address - Fax:989-837-9205
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
MI4301108579207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program