Provider Demographics
NPI:1962971358
Name:RAO, PRIYANKA (PSYD)
Entity type:Individual
Prefix:
First Name:PRIYANKA
Middle Name:
Last Name:RAO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2911 ENTERPRISE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MN
Mailing Address - Zip Code:55033-4157
Mailing Address - Country:US
Mailing Address - Phone:612-200-1504
Mailing Address - Fax:
Practice Address - Street 1:5200 WILLSON RD STE 210
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55424-1343
Practice Address - Country:US
Practice Address - Phone:612-324-0581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-15
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist