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NPI Code Detail

MEDICARE: NIRAJA SATHYANARAYANAN SURESH M.D.

MEDICARE: NIRAJA SATHYANARAYANAN SURESH M.D.
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
12084N0400XNeurology PhysicianME130820FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2F2WCPOTHERFLBLUE CROSS BLUE SHIELD
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1336482074
Entity Type Code : Individual
Provider Name (Legal Business Name) : NIRAJA SATHYANARAYANAN SURESH M.D.
Provider Business Mailing Address
First Line : PO BOX 917770
Second Line :
City : ORLANDO
State : FL
Zip : 32891-0001
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2400 KATHLEEN RD
Second Line :
City : LAKELAND
State : FL
Zip : 33810-3077
Country : US
Telephone Number : 863-284-6809
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/01/2013
Last Update Date : 03/12/2024

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