Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QG0300X | Family Doctor - Geriatric Medicine | 61511 | MN |
N | 207QG0300X | Family Doctor - Geriatric Medicine | LA.207015 | LA |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | ME130093 | FL |
NPI | 1033405329 |
---|---|
Provider Name | Piya Suryadevara |
First Address | South Miami, FL 33143-4679 |
Second Address | South Miami, FL 33143 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2011 |
Last Update Date | 24/04/2019 |