Provider Demographics
NPI:1689896276
Name:SHYLASREE KRISHNAN, PHYSICIAN, PLLC
Entity Type:Organization
Organization Name:SHYLASREE KRISHNAN, PHYSICIAN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHYLASREE
Authorized Official - Middle Name:
Authorized Official - Last Name:KRISHNAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-546-1272
Mailing Address - Street 1:220 ALEXANDER ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-4008
Mailing Address - Country:US
Mailing Address - Phone:585-546-1272
Mailing Address - Fax:585-325-4443
Practice Address - Street 1:220 ALEXANDER ST
Practice Address - Street 2:SUITE 106
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-4008
Practice Address - Country:US
Practice Address - Phone:585-546-1272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214408207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty