Provider Demographics
NPI:1972921930
Name:YELIKA, SURESH
Entity Type:Individual
Prefix:
First Name:SURESH
Middle Name:
Last Name:YELIKA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 NICOLLS RD # HSSC18
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-2900
Mailing Address - Country:US
Mailing Address - Phone:631-444-1825
Mailing Address - Fax:631-289-4718
Practice Address - Street 1:101 NICOLLS RD # HSSC18
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-2900
Practice Address - Country:US
Practice Address - Phone:631-444-1825
Practice Address - Fax:631-289-4718
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-06
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305226208600000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty