Healthcare Provider Details

I. General information

NPI: 1780644070
Provider Name (Legal Business Name): JASVANT S SURANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 08/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 37TH PL SUITE 104
VERO BEACH FL
32960-6501
US

IV. Provider business mailing address

1050 37TH PL SUITE 104
VERO BEACH FL
32960-6501
US

V. Phone/Fax

Practice location:
  • Phone: 772-569-3212
  • Fax: 772-569-1435
Mailing address:
  • Phone: 772-569-3212
  • Fax: 772-569-1435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1383591
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME103068
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: