Healthcare Provider Details

I. General information

NPI: 1073977328
Provider Name (Legal Business Name): DR. HIMANSHU SURI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2016
Last Update Date: 07/06/2022
Certification Date: 07/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 E HALLANDALE BEACH BLVD STE 211
HALLANDALE BEACH FL
33009-4835
US

IV. Provider business mailing address

3800 RESERVOIR RD NW DEPT OF MEDICINE
WASHINGTON DC
20007-2113
US

V. Phone/Fax

Practice location:
  • Phone: 954-457-0064
  • Fax:
Mailing address:
  • Phone: 202-444-8168
  • Fax: 877-303-1460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberD90123
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD048474
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number0101269788
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License NumberME156490
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: