Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0208X | Pediatric Infectious Diseases | 264579 | NY |
NPI | 1124295696 |
---|---|
Provider Name | Manika Suryadevara |
First Address | Syracuse, NY 13210-2342 |
Second Address | Syracuse, NY 13210-2342 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2008 |
Last Update Date | 27/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03470335 | (05) | NY |