Provider Demographics
NPI:1891195400
Name:APPALLA, SURYA DEEPIKA (MD)
Entity Type:Individual
Prefix:
First Name:SURYA DEEPIKA
Middle Name:
Last Name:APPALLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEEPIKA
Other - Middle Name:
Other - Last Name:APPALLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:8304 CARMEL RIDGE PL NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-2978
Mailing Address - Country:US
Mailing Address - Phone:513-800-8027
Mailing Address - Fax:
Practice Address - Street 1:1 UNIVERSITY OF NEW MEXICO # 105550
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-2723
Practice Address - Country:US
Practice Address - Phone:505-272-4661
Practice Address - Fax:505-272-0475
Is Sole Proprietor?:No
Enumeration Date:2014-09-02
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA44319208000000X
NMMD2019-0070208000000X, 2080S0012X, 390200000X
NMM2019-00702080A0000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No2080S0012XAllopathic & Osteopathic PhysiciansPediatricsSleep Medicine