Provider Demographics
NPI:1194092320
Name:SURUJBALLY, NADIA DONNA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:NADIA
Middle Name:DONNA
Last Name:SURUJBALLY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1443 NW 206TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-2466
Mailing Address - Country:US
Mailing Address - Phone:786-200-9677
Mailing Address - Fax:
Practice Address - Street 1:1443 NW 206TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-2466
Practice Address - Country:US
Practice Address - Phone:786-200-9677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS46461183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist