MEDICARE: SHYAMALA SURADA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP0007548	WV
2	183500000X	Pharmacist	52427	TX

General Provider Information

NPI Number	:	1295034999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHYAMALA SURADA

Provider Business Mailing Address
First Line	:	2323 LONG REACH DR
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77478-4190
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2323 LONG REACH DR
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77478-4190
Country	:	US
Telephone Number	:	571-230-2884
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2011
Last Update Date	:	01/23/2013

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Directions to “ SHYAMALA SURADA ” Practice Location

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