Basic Information
| Provider Information | |||||||||
| NPI: | 1790146413 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SURYADEVARA | ||||||||
| FirstName: | VALLABH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1901 N DUPONT HWY | ||||||||
| Address2: | SPRINGER BUILDING | ||||||||
| City: | NEW CASTLE | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197201100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3022552700 | ||||||||
| FaxNumber: | 3022554452 | ||||||||
| Practice Location | |||||||||
| Address1: | 1901 N DUPONT HWY | ||||||||
| Address2: | SPRINGER BUILDING | ||||||||
| City: | NEW CASTLE | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197201100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3022552700 | ||||||||
| FaxNumber: | 3022554452 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2016 | ||||||||
| LastUpdateDate: | 03/08/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | C7-0006129 | DE | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.