MEDICARE: CASSANDRA KRYSTA

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	106S00000X	Behavior Technician		GA

General Provider Information

NPI Number	:	1417811050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSANDRA KRYSTA

Provider Business Mailing Address
First Line	:	350 FAIRWAY DR STE 101
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33441-1834
Country	:	US
Telephone Number	:	877-418-2978
Fax Number	:	866-500-2186

Provider Business Practice Location Address
First Line	:	260 PEACHTREE ST NW STE 2200
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30303-1292
Country	:	US
Telephone Number	:	877-418-2978
Fax Number	:	866-500-2186

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

Provider Enumeration Date	:	12/09/2025
Last Update Date	:	12/09/2025

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Directions to “ CASSANDRA KRYSTA ” Practice Location

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