Provider Demographics
NPI:1770921132
Name:KRISHNARAO, PRIYA MENON (MD)
Entity type:Individual
Prefix:
First Name:PRIYA
Middle Name:MENON
Last Name:KRISHNARAO
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:PRIYA
Other - Middle Name:
Other - Last Name:MENON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2489 N LA CAPELLA CT
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-1918
Mailing Address - Country:US
Mailing Address - Phone:267-879-9306
Mailing Address - Fax:
Practice Address - Street 1:550 1ST AVE FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6402
Practice Address - Country:US
Practice Address - Phone:212-263-5230
Practice Address - Fax:646-754-9560
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-07
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1274182085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology