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General NPI Number Information
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NPI Number | 1639621345
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Entity Type | Organization
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Legal Business Name | FLORIDA ENDOCRINOLOGY GROUP LLC
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Dates
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Enumeration Date | 10/28/2016
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Last Update Date | 10/28/2016
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Provider Practice Location Address
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Address Line | 34041 US HIGHWAY 19 N SUITE C
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City | PALM HARBOR
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State | FL
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Zip | 34684-2648
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Country | US
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Telephone | 727-480-5619
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Fax |
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Provider Business Mailing Address
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Address Line | 34041 US HIGHWAY 19 N SUITE C
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City | PALM HARBOR
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State | FL
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Zip | 34684-2648
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Country | US
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Telephone | 727-480-5619
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SOMWYA SURYANARAYANAN
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Credential | M.D.
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Telephone | 727-480-5619
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | ME117683
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License Number State | FL
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