Provider Demographics
NPI:1437193604
Name:SUREDDI, PRASAD S (MD)
Entity Type:Individual
Prefix:DR
First Name:PRASAD
Middle Name:S
Last Name:SUREDDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:10 MAIN ST S
Mailing Address - Street 2:STE 3
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-2260
Mailing Address - Country:US
Mailing Address - Phone:203-757-2772
Mailing Address - Fax:203-757-5933
Practice Address - Street 1:10 MAIN ST S
Practice Address - Street 2:STE 3
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-2260
Practice Address - Country:US
Practice Address - Phone:203-757-2772
Practice Address - Fax:203-757-5933
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2018-01-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT024062208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT01002406201OtherANTHEM
D77062Medicare UPIN
CT01002406201OtherANTHEM