Healthcare Provider Details

I. General information

NPI: 1366942096
Provider Name (Legal Business Name): ANURADHA SURYA DEVARA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2018
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 MIAMI VALLEY DR STE 500
CENTERVILLE OH
45459-4780
US

IV. Provider business mailing address

6680 POE AVE STE 200
DAYTON OH
45414-2855
US

V. Phone/Fax

Practice location:
  • Phone: 937-293-1622
  • Fax: 937-245-6308
Mailing address:
  • Phone: 937-280-8400
  • Fax: 937-280-8373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.005443RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: