Individual
SURYA VAIDYANATHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
800 MEADOWS RD, SUITE 1C, BOCA RATON, FL 33486-2304
(561) 447-9341
Mailing address
951 NW 13TH ST, SUITE 1C, BOCA RATON, FL 33486-2359
(561) 447-9341
(561) 447-9352
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
110493
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004503200
—
FL
01
—
14JT0
BLUE CROSS AND BLUE SHIELD
FL
01
—
P01141616
RAILROAD-MEDICARE
FL
Enumeration date
05/17/2007
Last updated
09/24/2013
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