Provider Demographics
NPI:1770802779
Name:SRAKHAO, VERAANONG (MD)
Entity type:Individual
Prefix:DR
First Name:VERAANONG
Middle Name:
Last Name:SRAKHAO
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 1:100 WOODS RD
Mailing Address - Street 2:WMC, BEHAVIORAL HEALTH CENTER, ROOM N301
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595-1530
Mailing Address - Country:US
Mailing Address - Phone:914-493-8424
Mailing Address - Fax:
Practice Address - Street 1:100 WOODS RD
Practice Address - Street 2:WMC, BEHAVIORAL HEALTH CENTER, ROOM N301
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1530
Practice Address - Country:US
Practice Address - Phone:914-493-8424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-31
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KYR28172084P0800X
NY2713542084P0800X
NYFS33941952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program