Provider Demographics
NPI:1205210481
Name:SURI, DIVYA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DIVYA
Middle Name:
Last Name:SURI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 CHERRYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2208
Mailing Address - Country:US
Mailing Address - Phone:917-399-7750
Mailing Address - Fax:
Practice Address - Street 1:275 MAIN ST
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-2416
Practice Address - Country:US
Practice Address - Phone:914-285-0690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060629183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist