Provider Demographics
NPI:1649429630
Name:STURDIVANT, ANGELA M (MD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:STURDIVANT
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 1:210 WESTCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10604-2901
Mailing Address - Country:US
Mailing Address - Phone:914-831-6800
Mailing Address - Fax:914-831-6801
Practice Address - Street 1:330 BARCLAY AVE NE
Practice Address - Street 2:SUITE 304
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2556
Practice Address - Country:US
Practice Address - Phone:616-391-2160
Practice Address - Fax:616-391-0697
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY249087207VG0400X
MI4301108507207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology