Provider Demographics
NPI:1144898586
Name:UPRETI, SURYA B (CRNP)
Entity type:Individual
Prefix:MR
First Name:SURYA
Middle Name:B
Last Name:UPRETI
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:SUNNY
Other - Middle Name:
Other - Last Name:UPRETI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6132 KAREN DAVIE DR NW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806-1954
Mailing Address - Country:US
Mailing Address - Phone:256-698-4145
Mailing Address - Fax:
Practice Address - Street 1:2000 6TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-2110
Practice Address - Country:US
Practice Address - Phone:205-934-3338
Practice Address - Fax:205-934-2042
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-13
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-169397363LA2100X
AL1-167397363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty