Basic Information
| Provider Information | |||||||||
| NPI: | 1558327973 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SURYANARAYANAN | ||||||||
| FirstName: | SOWMYA | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M. D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | UNIVERSITY OF CENTRAL FLORIDA | ||||||||
| Address2: | 6850 LAKE NONA BLVD, 3RD FLOOR | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7276239913 | ||||||||
| FaxNumber: | 4072664910 | ||||||||
| Practice Location | |||||||||
| Address1: | 9975 TAVISTOCK LAKES BLVD STE 300 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328277665 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4072664900 | ||||||||
| FaxNumber: | 4072664910 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2006 | ||||||||
| LastUpdateDate: | 08/15/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | ME117683 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 010340900 | 05 | FL | MEDICAID | 42779022 | 05 | CO | MEDICAID |