Provider Demographics
NPI:1346538774
Name:SURYA, SANDARSH (MBBS)
Entity Type:Individual
Prefix:
First Name:SANDARSH
Middle Name:
Last Name:SURYA
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:997 SAINT SEBASTIAN WAY
Mailing Address - Street 2:DEPARTMENT OF PSYCHIATRY
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30912-2613
Mailing Address - Country:US
Mailing Address - Phone:314-662-1682
Mailing Address - Fax:336-716-7080
Practice Address - Street 1:1 MEDICAL CENTER BLVD
Practice Address - Street 2:DEPARTMENT OF PSYCHIATRY
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:314-662-1682
Practice Address - Fax:336-716-7080
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC172607390200000X
GA0755352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program