Provider Demographics
NPI:1376768366
Name:VENKATESH, PRIYA (MD)
Entity Type:Individual
Prefix:
First Name:PRIYA
Middle Name:
Last Name:VENKATESH
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:PO BOX 227102
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75222-7102
Mailing Address - Country:US
Mailing Address - Phone:972-801-2140
Mailing Address - Fax:972-599-9696
Practice Address - Street 1:5655 W SPRING CREEK PKWY STE 200
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-4175
Practice Address - Country:US
Practice Address - Phone:972-599-9600
Practice Address - Fax:972-599-9696
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD433637208000000X
MI4301084228208000000X
TXM9719208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics