Healthcare Provider Details

I. General information

NPI: 1538697115
Provider Name (Legal Business Name): SHREYA KRISHNAN MS,SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2017
Last Update Date: 05/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8550 CADENZA LN
DALLAS TX
75228-4923
US

IV. Provider business mailing address

800 W RENNER RD APT 3622
RICHARDSON TX
75080-1050
US

V. Phone/Fax

Practice location:
  • Phone: 214-328-4309
  • Fax:
Mailing address:
  • Phone: 585-770-3837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number112995
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: