Provider Demographics
NPI:1811122054
Name:SURI, SHAVETA (MA)
Entity type:Individual
Prefix:MRS
First Name:SHAVETA
Middle Name:
Last Name:SURI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:SHAVETA
Other - Middle Name:
Other - Last Name:GUJRAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1500 WHITSTABLE CT
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-4332
Mailing Address - Country:US
Mailing Address - Phone:407-731-0940
Mailing Address - Fax:
Practice Address - Street 1:1500 WHITSTABLE CT
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-4332
Practice Address - Country:US
Practice Address - Phone:407-731-0940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-18
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst