Provider Demographics
NPI:1932393519
Name:SHERPA, KANCHI MAYA (MD)
Entity Type:Individual
Prefix:
First Name:KANCHI
Middle Name:MAYA
Last Name:SHERPA
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 1:744 SHELDEN RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1511
Mailing Address - Country:US
Mailing Address - Phone:248-990-3018
Mailing Address - Fax:313-447-5846
Practice Address - Street 1:4646 JOHN R ST
Practice Address - Street 2:JOHN D. DINGELL VA MEDICAL CENTER
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-1916
Practice Address - Country:US
Practice Address - Phone:313-576-1000
Practice Address - Fax:313-576-1233
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2419102085R0202X, 207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine