Provider Demographics
NPI:1982593729
Name:SULYA, SURAJ (MBBS, MD)
Entity type:Individual
Prefix:
First Name:SURAJ
Middle Name:
Last Name:SULYA
Suffix:
Gender:M
Credentials:MBBS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N ROADRUNNER PKWY APT 1102
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-9056
Mailing Address - Country:US
Mailing Address - Phone:505-640-2341
Mailing Address - Fax:
Practice Address - Street 1:4351 E LOHMAN AVE STE 300
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8262
Practice Address - Country:US
Practice Address - Phone:505-640-2341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-28
Last Update Date:2025-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program