Provider Demographics
NPI:1518231380
Name:SURYAPRAGASAM, MAHARANI (SLP)
Entity Type:Individual
Prefix:MRS
First Name:MAHARANI
Middle Name:
Last Name:SURYAPRAGASAM
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 N DIAMOND BAR BLVD
Mailing Address - Street 2:SUITE B-2
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-1059
Mailing Address - Country:US
Mailing Address - Phone:909-396-8900
Mailing Address - Fax:
Practice Address - Street 1:706 N DIAMOND BAR BLVD
Practice Address - Street 2:SUITE B-2
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-1059
Practice Address - Country:US
Practice Address - Phone:909-396-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-26
Last Update Date:2012-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 17509235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist