Provider Demographics
NPI:1710327424
Name:SURAKANTI, SHRAVANI (MD)
Entity Type:Individual
Prefix:
First Name:SHRAVANI
Middle Name:
Last Name:SURAKANTI
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 1:4155 ESSEN LN
Mailing Address - Street 2:APT 135
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-2150
Mailing Address - Country:US
Mailing Address - Phone:765-366-5056
Mailing Address - Fax:
Practice Address - Street 1:8585 PICARDY AVE
Practice Address - Street 2:SUITE 414
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3748
Practice Address - Country:US
Practice Address - Phone:225-763-4764
Practice Address - Fax:225-763-4549
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAMD.303223207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2426966Medicaid