Provider Demographics
NPI:1447563515
Name:SOORIYAPALAN, NISHANTHINI (MD)
Entity Type:Individual
Prefix:
First Name:NISHANTHINI
Middle Name:
Last Name:SOORIYAPALAN
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 1:4071 LEE RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-2100
Mailing Address - Country:US
Mailing Address - Phone:216-957-1200
Mailing Address - Fax:216-752-0494
Practice Address - Street 1:4071 LEE RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-2100
Practice Address - Country:US
Practice Address - Phone:216-957-1200
Practice Address - Fax:216-752-0494
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35.121748207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program