Provider Demographics
NPI:1790741734
Name:KRISHNA, VASANTHI (MD)
Entity Type:Individual
Prefix:DR
First Name:VASANTHI
Middle Name:
Last Name:KRISHNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VASANTHI
Other - Middle Name:
Other - Last Name:KRISHNA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD,
Mailing Address - Street 1:87 SCRIPPS DR
Mailing Address - Street 2:STE 210
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-6372
Mailing Address - Country:US
Mailing Address - Phone:916-333-5311
Mailing Address - Fax:
Practice Address - Street 1:87 SCRIPPS DRIVE SUITE 210
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-7977
Practice Address - Country:US
Practice Address - Phone:916-333-5311
Practice Address - Fax:916-333-5990
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1192222084S0012X, 2084N0600X
CAA112222084N0400X
OH35.0867382084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology