Provider Demographics
NPI:1114975596
Name:RAO, SURYA PRAKASH (MD)
Entity Type:Individual
Prefix:
First Name:SURYA
Middle Name:PRAKASH
Last Name:RAO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:695 N CLYDE MORRIS BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-2321
Mailing Address - Country:US
Mailing Address - Phone:386-258-8722
Mailing Address - Fax:386-258-9443
Practice Address - Street 1:1404 S RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:FL
Practice Address - Zip Code:32132-2720
Practice Address - Country:US
Practice Address - Phone:386-258-8722
Practice Address - Fax:386-265-5928
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2021-01-12
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Provider Licenses
StateLicense IDTaxonomies
FLME96830207UN0901X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL281152900Medicaid
FL94219OtherBC/BS
FL281152900Medicaid
FLAA887TMedicare PIN