Provider Demographics
NPI:1558327973
Name:SURYANARAYANAN, SOWMYA K (M D)
Entity Type:Individual
Prefix:DR
First Name:SOWMYA
Middle Name:K
Last Name:SURYANARAYANAN
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF CENTRAL FLORIDA
Mailing Address - Street 2:6850 LAKE NONA BLVD, 3RD FLOOR
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827
Mailing Address - Country:US
Mailing Address - Phone:727-623-9913
Mailing Address - Fax:407-266-4910
Practice Address - Street 1:9975 TAVISTOCK LAKES BLVD STE 300
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-7665
Practice Address - Country:US
Practice Address - Phone:407-266-4900
Practice Address - Fax:407-266-4910
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME117683207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010340900Medicaid
CO42779022Medicaid
COCO40761Medicare PIN
I41416Medicare UPIN
FL010340900Medicaid
FLHP562YMedicare PIN
FLHP562XMedicare PIN