Provider Demographics
NPI:1689022105
Name:KRISHNARAO, TINA
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:
Last Name:KRISHNARAO
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 1:102 RIVERS EDGE RD
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-1163
Mailing Address - Country:US
Mailing Address - Phone:646-672-6767
Mailing Address - Fax:
Practice Address - Street 1:102 RIVERS EDGE RD
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-1163
Practice Address - Country:US
Practice Address - Phone:646-672-6767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-25
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3054282084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry