Provider Demographics
NPI:1710652276
Name:BHAVARAJU, SURYA APARNA
Entity Type:Individual
Prefix:
First Name:SURYA
Middle Name:APARNA
Last Name:BHAVARAJU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 CHESTNUT SPRINGS PL APT 1317
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23233-0221
Mailing Address - Country:US
Mailing Address - Phone:315-283-6356
Mailing Address - Fax:
Practice Address - Street 1:3904 HULL STREET RD STE A
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23224-1714
Practice Address - Country:US
Practice Address - Phone:804-233-0007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401417668122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist