Active NPI
Prasad S Sureddi, MD
- Plastic Surgery Physician
- Southbury, CT
National Provider Identifier
1437193604
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Plastic Surgery Physician
- License
- 024062
- Practice address
- 10 Main St S
Ste 3
Southbury, CT 06488-2260 - Phone
- (203) 757-2772
- Fax
- (203) 757-5933
- NPI assigned
- Jun 16, 2006
- Last updated
- Jan 29, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Plastic Surgery Physician | 208200000X | 024062 | CT | Primary |
Addresses
Primary practice location
10 Main St S
Ste 3
Southbury, CT 06488-2260
Mailing address
10 Main St S
Ste 3
Southbury, CT 06488-2260
Phone (203) 757-2772
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01002406201 | Other | CT | ANTHEM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 1, 2024 through Apr 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 024062 | CT | MD | Plastic Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aesthetique, Cosmetic and Laser Surgery Center, LLC | Past | Accepting new patients |
Interoperability endpoints
- psureddi@direct.wtbyhosp.org
- psureddi@directaddress.net
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Specialist
- Southbury, CT
- NPI 1023358488
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150416000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1517184000000",
"number": "1437193604",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 MAIN ST S",
"address_2": "STE 3",
"city": "SOUTHBURY",
"state": "CT",
"postal_code": "064882260",
"telephone_number": "203-757-2772",
"fax_number": "203-757-5933"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10 MAIN ST S",
"address_2": "STE 3",
"city": "SOUTHBURY",
"state": "CT",
"postal_code": "064882260",
"telephone_number": "203-757-2772",
"fax_number": "203-757-5933"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUREDDI",
"first_name": "PRASAD",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-06-16",
"last_updated": "2018-01-29",
"status": "A"
},
"taxonomies": [
{
"code": "208200000X",
"taxonomy_group": "",
"desc": "Plastic Surgery",
"state": "CT",
"license": "024062",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "01002406201",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Southbury, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.