Provider Demographics
NPI:1811032485
Name:DUBOSE PARSONS, SHERIDA DANIELLE (MD)
Entity Type:Individual
Prefix:
First Name:SHERIDA
Middle Name:DANIELLE
Last Name:DUBOSE PARSONS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHERIDA
Other - Middle Name:DANIELLE
Other - Last Name:DUBOSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4201 ST. ANTOINE
Mailing Address - Street 2:UNIVERSITY PEDIATRICIANS UHC 5D MAILBOX# 226
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201
Mailing Address - Country:US
Mailing Address - Phone:313-966-5051
Mailing Address - Fax:313-966-0665
Practice Address - Street 1:3901 BEAUBIEN
Practice Address - Street 2:CHILDREN'S HOSPITAL OF MI
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-745-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI01078465208000000X
MI43010784652080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIQ24657046Medicare PIN