Individual
SURATKAL V SHENOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.F.A.C.S
Contact information
Practice address
ROUTE 220 SOUTH, STAGGS LANE, KEYSER, WV 26726-0929
(304) 788-6566
(301) 786-7050
Mailing address
PO BOX 929, KEYSER, WV 26726-0929
(304) 788-6566
(301) 786-7050
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
12745
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0128297000
—
WV
Enumeration date
10/26/2006
Last updated
12/04/2007
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