Individual
SURYA PRAKASH RAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1404 S RIDGEWOOD AVE, EDGEWATER, FL 32132-2720
(386) 258-8722
(386) 265-5928
Mailing address
695 N CLYDE MORRIS BLVD, DAYTONA BEACH, FL 32114-2321
(386) 258-8722
(386) 258-9443
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
ME96830
FL
207UN0901X
Nuclear Cardiology Physician
ME96830
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
281152900
—
FL
01
—
94219
BC/BS
FL
Enumeration date
05/05/2006
Last updated
01/12/2021
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