MEDICARE: J SURANI PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080A0000X	Pediatric Adolescent Medicine Physician	ME103068	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164724340
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J SURANI PA

Provider Business Mailing Address
First Line	:	777 37TH ST STE B102
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-4897
Country	:	US
Telephone Number	:	772-569-3212
Fax Number	:

Provider Business Practice Location Address
First Line	:	777 37TH ST STE B102
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-4897
Country	:	US
Telephone Number	:	772-569-3212
Fax Number	:	772-569-1435

Authorized Official
Title or Position	:	BILLING
Name	:	PEGGIE CALAHAN
Credential	:
Telephone Number	:	772-569-3212

Provider Enumeration Date	:	11/22/2010
Last Update Date	:	04/05/2012

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Directions to “J SURANI PA ” Practice Location

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