Provider Demographics
NPI:1457408932
Name:KRISHNAMURTHY, RAJASRI P (MD)
Entity type:Individual
Prefix:DR
First Name:RAJASRI
Middle Name:P
Last Name:KRISHNAMURTHY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 411685
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32941-1685
Mailing Address - Country:US
Mailing Address - Phone:321-622-8626
Mailing Address - Fax:321-622-8627
Practice Address - Street 1:2795 W NEW HAVEN AVE
Practice Address - Street 2:
Practice Address - City:WEST MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-3705
Practice Address - Country:US
Practice Address - Phone:321-622-8626
Practice Address - Fax:321-622-8627
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2025-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97696207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277483600Medicaid
FLAB134XOtherMEDICARE
FLME97696OtherMEDICAL LICENSE
FLPO1346567OtherRRMR
FLP00431570OtherRR MEDICARE