MEDICARE: JASVANT S SURANI 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	208000000X	Pediatrics Physician	1383591	NY
2	208000000X	Pediatrics Physician	ME103068	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000401250001	OTHER		BLUE SHIELD
2	76E60	OTHER		EMPIRE BC
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	040426006769	OTHER		FIDELIS
5	26112	OTHER	NY	MVP
6	10002697	OTHER	NY	CPHP

General Provider Information

NPI Number	:	1780644070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASVANT S SURANI MD

Provider Business Mailing Address
First Line	:	1050 37TH PL
Second Line	:	SUITE 104
City	:	VERO BEACH
State	:	FL
Zip	:	32960-6501
Country	:	US
Telephone Number	:	772-569-3212
Fax Number	:	772-569-1435

Provider Business Practice Location Address
First Line	:	1050 37TH PL
Second Line	:	SUITE 104
City	:	VERO BEACH
State	:	FL
Zip	:	32960-6501
Country	:	US
Telephone Number	:	772-569-3212
Fax Number	:	772-569-1435

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

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	08/27/2014

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Directions to “ JASVANT S SURANI MD” Practice Location

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