Active NPI
Madelia Suravilla, RN
- Registered Nurse
- New York, NY
National Provider Identifier
1801046412
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 00396601
- Practice address
- 219 E 121St Street
New York, NY 10035-3018 - Phone
- (212) 987-5133
- NPI assigned
- Sep 19, 2008
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 00396601 | NY | Primary |
Addresses
Primary practice location
219 E 121St Street
New York, NY 10035-3018
Mailing address
95 Pine Street
17TH Floor Odyssey House, Inc
New York, NY 10005
Phone (212) 987-5133
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00396601 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00396601 | NY | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1221782400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1221782400000",
"number": "1801046412",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "95 PINE STREET",
"address_2": "17TH FLOOR ODYSSEY HOUSE, INC",
"city": "NEW YORK",
"state": "NY",
"postal_code": "10005",
"telephone_number": "212-987-5133"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "219 E 121ST STREET",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100353018",
"telephone_number": "212-987-5133"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SURAVILLA",
"first_name": "MADELIA",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-09-19",
"last_updated": "2008-09-19",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "NY",
"license": "00396601",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00396601",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.