Provider Demographics
NPI:1407545916
Name:KRISHNAN, SRIPRIYA
Entity Type:Individual
Prefix:MRS
First Name:SRIPRIYA
Middle Name:
Last Name:KRISHNAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 DALE DR
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2240
Mailing Address - Country:US
Mailing Address - Phone:908-838-3986
Mailing Address - Fax:
Practice Address - Street 1:26 HEATHCOTE AVE
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-4769
Practice Address - Country:US
Practice Address - Phone:908-838-3986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst