MAHENDER REDDY SURAKANTI (NPI# 1417940909) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417940909 |
| Entity Type | Individual |
| Full Name | MAHENDER REDDY SURAKANTI |
| Credential | MD |
| Practice Address |
7806 W Jefferson Blvd Ste C Fort Wayne IN 46804 |
| Mailing Address |
10214 Chestnut Plaza Dr # 306 Fort Wayne IN 46814-8970 |
| Practice Telephone | 2602034188 |
| Mailing Telephone | 2602034188 |
| Mailing Fax Number | 2602035136 |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2018-05-25 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
01057700A | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 200442540A | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 800 Broadway Ste 208, Fort Wayne, IN 468022149 | 2604253204 | 2604253206 |
| Street Address |
7806 W JEFFERSON BLVD STE C |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46804 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851309876 | Mary A Larocque | Social Worker | 7806 W Jefferson Blvd Ste C, Fort Wayne, IN 46804-4180 | 2006-08-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396350344 | Derek Mumaw | Physical Therapist | 8420 Illinois Rd, Fort Wayne, IN 46804 | 2020-09-15 |
| 1942840228 | Erin M Mason | Behavior Technician | 5601 Coventry Ln, Fort Wayne, IN 46804 | 2020-01-14 |
| 1346880879 | Emily A Abdalla | Behavior Technician | 5601 Coventry Ln., Fort Wayne, IN 46804 | 2020-01-13 |
| 1083265433 | Fort Wayne Endodontics | Dentist | 9407 Illinois Rd, Fort Wayne, IN 46804 | 2019-09-26 |
| 1689140949 | Harrison Dental Group II, LLC | Dentist | 1333 Getz Rd, Fort Wayne, IN 46804 | 2018-10-15 |
| 1346731908 | Erin Nicole Zimmerman | Nurse Practitioner | 10170 Illinois Rd # 14, Fort Wayne, IN 46804 | 2018-05-19 |
| 1417446022 | Mary Harrington | Physical Therapist | 3320 Copper Hill Run, Fort Wayne, IN 46804 | 2018-05-09 |
| 1942701214 | Joshawa Todd Torres | Marriage & Family Therapist | 5651 Coventry Ln # 116, Fort Wayne, IN 46804 | 2018-02-22 |
| 1194235408 | Mitchell Kory Meyer | Specialist/Technologist | 9125 Yellow Tree Ct, Fort Wayne, IN 46804 | 2017-10-02 |
| 1902324916 | Emily Rene Sagstetter | Specialist/Technologist | 6034 Liberty Glade Ct, Fort Wayne, IN 46804 | 2017-08-30 |
| Find all providers in zip 46804 | ||||
| Taxonomy Code | 2084P0800X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Psychiatry |
| A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407166077 | Professional Psychiatric Services, LLC | Psychiatry & Neurology | 6203 Constitution Dr, Fort Wayne, IN 46804-1517 | 2010-10-18 |
| 1023233939 | David T Holmes Md PC | Psychiatry & Neurology | 7224 Engle Rd # 120, Fort Wayne, IN 46804-2222 | 2007-04-16 |
| 1447303326 | Joseph Paul Fiacable | Psychiatry & Neurology | 2426 Lake Ave, Fort Wayne, IN 46805-5406 | 2007-01-22 |
| 1013072180 | Raj Clinics Professional Services Corporation | Psychiatry & Neurology | 315 Airport North Office Park, Fort Wayne, IN 46825-6703 | 2006-12-27 |
| 1588676415 | S. Christopher Shim | Psychiatry & Neurology | 415 E Cook Rd Ste 500, Fort Wayne, IN 46825-3657 | 2006-08-12 |
| 1316980576 | Ronald Jerry Pancner | Psychiatry & Neurology | 2805 Fairfield Ave, Fort Wayne, IN 46807-1218 | 2006-06-14 |
| 1790762078 | Alycia Brown | Psychiatry & Neurology | 1818 Carew St Ste 230, Fort Wayne, IN 46805-4764 | 2005-12-28 |
| 1245237411 | Prevesh K Rustagi | Psychiatry & Neurology | 3400 E Coliseum Blvd, Suite 340, Fort Wayne, IN 46805-1644 | 2005-07-03 |
| 1619377280 | Vinita Prasad | Psychiatry & Neurology | 1818 Carew St Ste 230, Fort Wayne, IN 46805 | 2014-09-02 |
| 1487071809 | Andrea Naaum | Psychiatry & Neurology | 1909 Carew St, Fort Wayne, IN 46805 | 2014-03-24 |
| Find all providers in FORT WAYNE | ||||
| City | FORT WAYNE |
| Zip Code | 46804 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.