Provider Demographics
NPI:1962464511
Name:SRIKRISHNA, INC.
Entity Type:Organization
Organization Name:SRIKRISHNA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROOPA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHALLAPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-419-6824
Mailing Address - Street 1:2 CARTERS GRV
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-3053
Mailing Address - Country:US
Mailing Address - Phone:585-419-6824
Mailing Address - Fax:585-419-6823
Practice Address - Street 1:1425 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3001
Practice Address - Country:US
Practice Address - Phone:585-922-4394
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182242-12084P0804X
NY1826772084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
Not Answered2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G0185023590OtherBCBS MANAGED CARE
AA0097Medicare ID - Type Unspecified