Provider Demographics
NPI:1750679916
Name:SWARUP, SUPREEYA (DO)
Entity Type:Individual
Prefix:
First Name:SUPREEYA
Middle Name:
Last Name:SWARUP
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 NEWBRIDGE RD
Mailing Address - Street 2:APT 11
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-4122
Mailing Address - Country:US
Mailing Address - Phone:209-518-2441
Mailing Address - Fax:
Practice Address - Street 1:6005 PARK AVE STE 500B
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5215
Practice Address - Country:US
Practice Address - Phone:901-683-6925
Practice Address - Fax:901-684-1435
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-20
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TN3723207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program