Healthcare Provider Details

I. General information

NPI: 1376768366
Provider Name (Legal Business Name): PRIYA VENKATESH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 01/03/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5655 W SPRING CREEK PKWY STE 200
PLANO TX
75024-4175
US

IV. Provider business mailing address

PO BOX 227102
DALLAS TX
75222-7102
US

V. Phone/Fax

Practice location:
  • Phone: 972-599-9600
  • Fax: 972-599-9696
Mailing address:
  • Phone: 972-801-2140
  • Fax: 972-599-9696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD433637
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301084228
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberM9719
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: