Provider Demographics
NPI:1154965507
Name:SURESH, NIVEDITA (MD)
Entity type:Individual
Prefix:DR
First Name:NIVEDITA
Middle Name:
Last Name:SURESH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 PRESIDENTIAL PLZ APT 711
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-2275
Mailing Address - Country:US
Mailing Address - Phone:716-408-7420
Mailing Address - Fax:
Practice Address - Street 1:750 E ADAMS ST DEPT OF
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2306
Practice Address - Country:US
Practice Address - Phone:315-464-7120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program