Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | R8279 | TX |
NPI | 1538455811 |
---|---|
Provider Name | Dr. Devaki Shilpa Sudha Surasi |
First Address | Houston, TX 77210-4439 |
Second Address | Houston, TX 77030-4000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2011 |
Last Update Date | 18/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
392270001 | (05) | TX |
392270002 | MEDICAID-CSHCN (01) | TX |
8KA008 | BCBS (01) | TX |
P02163541 | RAILROAD MEDICARE (01) | TX |