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General NPI Number Information
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NPI Number | 1386627065
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Entity Type | Individual
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Provider Name | SURESH V. UNDAVIA MD
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Gender | Male
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Dates
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Enumeration Date | 11/27/2005
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Last Update Date | 03/11/2014
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Provider Practice Location Address
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Address Line | 114 CLAYTON AVE
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City | VESTAL
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State | NY
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Zip | 13850-2430
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Country | US
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Telephone | 607-785-4277
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Fax | 607-785-3617
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Provider Business Mailing Address
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Address Line | PO BOX 645 114 CLAYTON AVENUE
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City | VESTAL
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State | NY
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Zip | 13850-0645
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Country | US
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Telephone | 607-785-4277
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Fax | 607-785-3617
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084F0202X
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Taxonomy Name | Forensic Psychiatry Physician
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License Number | 122304
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 122304
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number | 122304
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number | 122304
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License Number State | NY
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Taxonomy #5
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 122304
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License Number State | NY
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Taxonomy #6
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | NY122304
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License Number State | NY
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Taxonomy #7
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 122304
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License Number State | NY
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