Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 4301103431 | MI |
Y | 2080P0216X | Pediatric Rheumatologist | 300103 | NY |
NPI | 1649618638 |
---|---|
Provider Name | Anjali Sethi Sura |
First Address | Syracuse, NY 13212-4516 |
Second Address | Syacuse, NY 13210 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2013 |
Last Update Date | 12/08/2019 |