MEDICARE: KRYSTLE A CARDONA HAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237700000X	Hearing Instrument Specialist	AS 4926	FL

General Provider Information

NPI Number	:	1053732172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRYSTLE A CARDONA HAS

Provider Business Mailing Address
First Line	:	750 N COMMONS DR STE 200
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60504-8025
Country	:	US
Telephone Number	:	630-303-5380
Fax Number	:	630-303-5385

Provider Business Practice Location Address
First Line	:	12381 S CLEVELAND AVE STE 405
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-3853
Country	:	US
Telephone Number	:	239-461-9321
Fax Number	:	239-461-5354

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2013
Last Update Date	:	02/12/2025

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