Doctor Name: | MADHU SURYADEVARA |
NPI Number: | 1578906772 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | |
Business Practice Address: | 2390 W Congress St Lafayette, LA - 705064205 |
Business Phone Number: | 3478813225 |
Business Fax Number: | |
Mailing Address: | 8703 256th St, FLORAL PARK |
State: | NY |
Postal Code: | 110011407 |
Phone Number: | 6463384696 |
Fax Number: | |
NPI Enumeration Date: | 04/08/2013 |
NPI Last Update Date: | 06/13/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |