Provider Demographics
NPI:1982223632
Name:SURYADEVARA, TEJESWI (MBBS)
Entity type:Individual
Prefix:DR
First Name:TEJESWI
Middle Name:
Last Name:SURYADEVARA
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 29650
Mailing Address - Street 2:DEPT # 880504
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038-9650
Mailing Address - Country:US
Mailing Address - Phone:702-707-6960
Mailing Address - Fax:
Practice Address - Street 1:3201 S MARYLAND PKWY STE 318
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2425
Practice Address - Country:US
Practice Address - Phone:702-707-6960
Practice Address - Fax:702-707-6956
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-13
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV274512084N0400X
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology