Provider Demographics
NPI:1467610568
Name:PANCHAL, KRISHNA R (MS)
Entity Type:Individual
Prefix:
First Name:KRISHNA
Middle Name:R
Last Name:PANCHAL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11405 WINDSOR POINTE DR
Mailing Address - Street 2:APT. 203
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-2740
Mailing Address - Country:US
Mailing Address - Phone:407-310-8523
Mailing Address - Fax:
Practice Address - Street 1:1412 TECH BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-7865
Practice Address - Country:US
Practice Address - Phone:813-635-9765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH6788101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health