Healthcare Provider Details

I. General information

NPI: 1558327973
Provider Name (Legal Business Name): SOWMYA K SURYANARAYANAN M. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3724 RALEIGH ROAD PKWY W
WILSON NC
27896-9742
US

IV. Provider business mailing address

3724 RALEIGH ROAD PKWY W
WILSON NC
27896-9742
US

V. Phone/Fax

Practice location:
  • Phone: 252-246-8840
  • Fax: 252-246-8841
Mailing address:
  • Phone: 252-246-8840
  • Fax: 252-246-8841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number2019-01162
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberME117683
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: