Provider Demographics
NPI:1528372505
Name:SABBENAHALLI, SURESH (MD)
Entity Type:Individual
Prefix:
First Name:SURESH
Middle Name:
Last Name:SABBENAHALLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SWAMY SURESH BABU
Other - Middle Name:
Other - Last Name:SABBENAHALLI NARAYANA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1006 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4103
Mailing Address - Country:US
Mailing Address - Phone:318-222-6226
Mailing Address - Fax:318-222-6227
Practice Address - Street 1:1006 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4103
Practice Address - Country:US
Practice Address - Phone:318-222-6226
Practice Address - Fax:318-222-6227
Is Sole Proprietor?:No
Enumeration Date:2010-08-02
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD2064232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry