Healthcare Provider Details

I. General information

NPI: 1891195400
Provider Name (Legal Business Name): SURYA DEEPIKA APPALLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEEPIKA APPALLA MD

II. Dates (important events)

Enumeration Date: 09/02/2014
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UNIVERSITY OF NEW MEXICO # 105550
ALBUQUERQUE NM
87131-2723
US

IV. Provider business mailing address

8304 CARMEL RIDGE PL NE
ALBUQUERQUE NM
87122-2978
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-4661
  • Fax: 505-272-0475
Mailing address:
  • Phone: 513-800-8027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number44319
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD2019-0070
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberM2019-0070
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code2080S0012X
TaxonomyPediatric Sleep Medicine Physician
License NumberMD2019-0070
License Number StateNM
# 5
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMD2019-0070
License Number StateNM
# 6
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: