Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | MD60003283 | WA |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 251462-1 | NY |
NPI | 1255599494 |
---|---|
Provider Name | Amar C Suryadevara |
First Address | Syracuse, NY 13210-2342 |
Second Address | Syracuse, NY 13210-2342 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2008 |
Last Update Date | 10/08/2009 |