Provider Demographics
NPI:1245205145
Name:KRISHNA, SUNANDA (MD)
Entity Type:Individual
Prefix:DR
First Name:SUNANDA
Middle Name:
Last Name:KRISHNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 PLAZA DR
Mailing Address - Street 2:SUITE 14
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08757-3759
Mailing Address - Country:US
Mailing Address - Phone:732-240-0303
Mailing Address - Fax:732-240-2430
Practice Address - Street 1:3 PLAZA DR
Practice Address - Street 2:SUITE 14
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08757-3759
Practice Address - Country:US
Practice Address - Phone:732-240-0303
Practice Address - Fax:732-240-2430
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA069912207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ038469Medicare ID - Type Unspecified
NJH06888Medicare UPIN