Provider Demographics
NPI:1871554147
Name:NAYAK, SURESH R (MD)
Entity type:Individual
Prefix:
First Name:SURESH
Middle Name:R
Last Name:NAYAK
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:200 JOSE FIGUERES AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1500
Mailing Address - Country:US
Mailing Address - Phone:408-279-3692
Mailing Address - Fax:408-347-0353
Practice Address - Street 1:200 JOSE FIGUERES AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1500
Practice Address - Country:US
Practice Address - Phone:408-279-3692
Practice Address - Fax:408-347-0353
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2011-06-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA33868207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A338680-0Medicaid
CAA27276Medicare UPIN