Provider Demographics
NPI:1760571947
Name:RAJADHYAKSHA, KRISHNA DILIP (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISHNA
Middle Name:DILIP
Last Name:RAJADHYAKSHA
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 1:1800 N BAYSHORE DR
Mailing Address - Street 2:APT 3001
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33132-3251
Mailing Address - Country:US
Mailing Address - Phone:508-963-4213
Mailing Address - Fax:
Practice Address - Street 1:1800 N BAYSHORE DR
Practice Address - Street 2:APT 3001
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33132-3251
Practice Address - Country:US
Practice Address - Phone:508-963-4213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA42000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
A66307Medicare UPIN