Healthcare Provider Details

I. General information

NPI: 1447403340
Provider Name (Legal Business Name): MEERA SURUJDAI BEHARRY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2008
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 HARBOUR ISLE DR W UNIT PH01
FORT PIERCE FL
34949-2768
US

IV. Provider business mailing address

PO BOX 4455
FORT PIERCE FL
34948-4455
US

V. Phone/Fax

Practice location:
  • Phone: 254-718-7559
  • Fax:
Mailing address:
  • Phone: 254-718-7559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number228681
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberP4286
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberME147988
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: