Individual
MANIKA SURYADEVARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
750 E ADAMS ST, SYRACUSE, NY 13210-2342
(315) 464-5450
(315) 464-6322
Mailing address
750 E ADAMS ST, SYRACUSE, NY 13210-2342
(315) 464-5450
(315) 464-6322
Taxonomy
Speciality
Code
Description
License number
State
2080P0208X
Pediatric Infectious Diseases Physician
264579
NY
208M00000X
Hospitalist Physician
Primary
264579
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03470335
—
NY
Enumeration date
05/13/2008
Last updated
08/27/2013
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