Provider Demographics
NPI:1720667561
Name:KRISHNLAL, JEVENA ANNA
Entity Type:Individual
Prefix:
First Name:JEVENA
Middle Name:ANNA
Last Name:KRISHNLAL
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 1:9411 82ND PL
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11416-1202
Mailing Address - Country:US
Mailing Address - Phone:336-480-5027
Mailing Address - Fax:
Practice Address - Street 1:9411 82ND PL
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11416-1202
Practice Address - Country:US
Practice Address - Phone:336-480-5027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst