MEDICARE: NARENDIR T SOORYA INC

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	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1396865499
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NARENDIR T SOORYA INC

Provider Business Mailing Address
First Line	:	6651 CHIPPEWA
Second Line	:
City	:	ST LOUIS
State	:	MO
Zip	:	63109-2538
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6651 CHIPPEWA
Second Line	:
City	:	ST LOUIS
State	:	MO
Zip	:	63109-2538
Country	:	US
Telephone Number	:	314-644-2395
Fax Number	:	314-644-5917

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NARENDIR T SOORYA
Credential	:	MD
Telephone Number	:	314-644-2395

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	08/22/2020

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