Provider Demographics
NPI:1780644070
Name:SURANI, JASVANT S (MD)
Entity Type:Individual
Prefix:
First Name:JASVANT
Middle Name:S
Last Name:SURANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 37TH PL
Mailing Address - Street 2:SUITE 104
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6501
Mailing Address - Country:US
Mailing Address - Phone:772-569-3212
Mailing Address - Fax:772-569-1435
Practice Address - Street 1:1050 37TH PL
Practice Address - Street 2:SUITE 104
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6501
Practice Address - Country:US
Practice Address - Phone:772-569-3212
Practice Address - Fax:772-569-1435
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1383591208000000X
FLME103068208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
000401250001OtherBLUE SHIELD
76E60OtherEMPIRE BC
NY00561486Medicaid
040426006769OtherFIDELIS
NY26112OtherMVP
NY10002697OtherCPHP
E67958Medicare UPIN