Provider Demographics
NPI:1104613892
Name:SURAPANENI, NISHANT VENKAT (MD)
Entity type:Individual
Prefix:
First Name:NISHANT
Middle Name:VENKAT
Last Name:SURAPANENI
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5021 E CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-3631
Mailing Address - Country:US
Mailing Address - Phone:714-989-3559
Mailing Address - Fax:
Practice Address - Street 1:2001 W 68TH ST FL 33016
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1898
Practice Address - Country:US
Practice Address - Phone:305-823-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program