Provider Demographics
NPI:1548379241
Name:SUNKAVALLI, SURYANARAYANA (MD)
Entity Type:Individual
Prefix:
First Name:SURYANARAYANA
Middle Name:
Last Name:SUNKAVALLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4540 SW 52ND CIR
Mailing Address - Street 2:APT 108
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-9784
Mailing Address - Country:US
Mailing Address - Phone:352-237-6369
Mailing Address - Fax:
Practice Address - Street 1:1801 SE 32ND AVE
Practice Address - Street 2:MARION COUNTY HEALTH DEPT
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471
Practice Address - Country:US
Practice Address - Phone:352-629-0137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0044107207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
42185Medicare ID - Type Unspecified
U54808Medicare UPIN