Provider Demographics
NPI:1649280223
Name:SURYADEVARA, RAVEENDRA BABU (MD)
Entity type:Individual
Prefix:DR
First Name:RAVEENDRA
Middle Name:BABU
Last Name:SURYADEVARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8295 MOZLEY PARK ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-4633
Mailing Address - Country:US
Mailing Address - Phone:702-406-8408
Mailing Address - Fax:702-413-6867
Practice Address - Street 1:8295 MOZLEY PARK ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-4633
Practice Address - Country:US
Practice Address - Phone:702-406-8408
Practice Address - Fax:702-413-6867
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV138282084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F96265Medicare UPIN