MEDICARE: KINJAL SURYAWALA MD

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	2080P0206X	Pediatric Gastroenterology Physician	ME127948	FL
2	208000000X	Pediatrics Physician	MD.205648	LA
3	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1407099849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KINJAL SURYAWALA MD

Provider Business Mailing Address
First Line	:	130 TAMIAMI TRL N STE 100
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34102-6231
Country	:	US
Telephone Number	:	239-540-8262
Fax Number	:	239-323-0921

Provider Business Practice Location Address
First Line	:	130 TAMIAMI TRL N STE 100
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34102-6231
Country	:	US
Telephone Number	:	239-540-8262
Fax Number	:	239-323-0921

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

Provider Enumeration Date	:	04/15/2009
Last Update Date	:	01/23/2026

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