Healthcare Provider Details

I. General information

NPI: 1609364819
Provider Name (Legal Business Name): SRIVYSHNAVI SURAPANENI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 GENTILLY BLVD
NEW ORLEANS LA
70122-3854
US

IV. Provider business mailing address

1395 NW 167TH ST
MIAMI GARDENS FL
33169-5710
US

V. Phone/Fax

Practice location:
  • Phone: 504-383-0599
  • Fax:
Mailing address:
  • Phone: 504-383-0599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberV8173
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number328769
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: