Provider Demographics
NPI:1366488769
Name:SURESH, SALEELA (MD)
Entity Type:Individual
Prefix:DR
First Name:SALEELA
Middle Name:
Last Name:SURESH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3024
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14240-3024
Mailing Address - Country:US
Mailing Address - Phone:716-773-5892
Mailing Address - Fax:716-773-5892
Practice Address - Street 1:565 ABBOTT RD
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14220-2039
Practice Address - Country:US
Practice Address - Phone:716-821-4450
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1395521225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00010175501OtherUNIVERA
NY050127000043OtherFIDELIS
NY000507920001OtherBLUES
NY3001287OtherIHA
NY10175501OtherUNIVERA BEECH
NY10175501OtherUNIVERA BEECH
NY050127000043OtherFIDELIS