Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 42283 | TN |
NPI | 1003992686 |
---|---|
Provider Name | Dr. Nisha K Surenderanath |
First Address | Chattanooga, TN 37421-3379 |
Second Address | Knoxville, TN 37916-2231 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2006 |
Last Update Date | 14/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3000900 | (05) | TN |