Provider Demographics
NPI:1609831825
Name:MISTRY, SUHASINI S (MD)
Entity Type:Individual
Prefix:DR
First Name:SUHASINI
Middle Name:S
Last Name:MISTRY
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 1:18420 FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-3588
Mailing Address - Country:US
Mailing Address - Phone:734-425-5320
Mailing Address - Fax:734-425-6212
Practice Address - Street 1:18420 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-3588
Practice Address - Country:US
Practice Address - Phone:734-425-5320
Practice Address - Fax:734-425-6212
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISM0479722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2826930Medicaid
MIOH28401OtherBLUE CROSS BLUE SHIELD
MIOH28401OtherBLUE CROSS BLUE SHIELD
MIA78812Medicare UPIN