Active NPI
Raveendra Babu Suryadevara, M.D
- Psychiatry Physician
- Las Vegas, NV
National Provider Identifier
1649280223
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 13828
- Practice address
- 8295 Mozley Park St
Las Vegas, NV 89113-4633 - Phone
- (702) 406-8408
- Fax
- (702) 413-6867
- NPI assigned
- Aug 8, 2006
- 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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 13828 | NV | Primary |
Addresses
Primary practice location
8295 Mozley Park St
Las Vegas, NV 89113-4633
Mailing address
8295 Mozley Park St
Las Vegas, NV 89113-4633
Phone (702) 406-8408
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13828 | NV | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154995200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1718064000000",
"number": "1649280223",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8295 MOZLEY PARK ST",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891134633",
"telephone_number": "702-406-8408",
"fax_number": "702-413-6867"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8295 MOZLEY PARK ST",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891134633",
"telephone_number": "702-406-8408",
"fax_number": "702-413-6867"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SURYADEVARA",
"first_name": "RAVEENDRA",
"middle_name": "BABU",
"name_prefix": "Dr.",
"credential": "M.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-08",
"last_updated": "2024-06-11",
"certification_date": "2024-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "NV",
"license": "13828",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.