Provider Demographics
NPI:1780928432
Name:SURASKY, ABIGAIL (LAC)
Entity type:Individual
Prefix:MS
First Name:ABIGAIL
Middle Name:
Last Name:SURASKY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2206 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94703-1714
Mailing Address - Country:US
Mailing Address - Phone:510-845-8017
Mailing Address - Fax:
Practice Address - Street 1:1911 ADDISON ST STE 102
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-1267
Practice Address - Country:US
Practice Address - Phone:510-845-8017
Practice Address - Fax:844-649-0670
Is Sole Proprietor?:No
Enumeration Date:2012-11-19
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC3154171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist