Provider Demographics
NPI:1720396096
Name:SURIA PLASTIC SURGERY P.L.
Entity Type:Organization
Organization Name:SURIA PLASTIC SURGERY P.L.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHASHIDHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KUSUMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-472-8355
Mailing Address - Street 1:8430 W BROWARD BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2700
Mailing Address - Country:US
Mailing Address - Phone:954-472-8355
Mailing Address - Fax:954-472-8220
Practice Address - Street 1:8430 W BROWARD BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2700
Practice Address - Country:US
Practice Address - Phone:954-472-8355
Practice Address - Fax:954-472-8220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty