Healthcare Provider Details

I. General information

NPI: 1548840721
Provider Name (Legal Business Name): KRISTYN M. LAO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1351 WASHINGTON BLVD FL 5
STAMFORD CT
06902-2419
US

IV. Provider business mailing address

1351 WASHINGTON BLVD FL 5
STAMFORD CT
06902-2419
US

V. Phone/Fax

Practice location:
  • Phone: 203-388-1600
  • Fax:
Mailing address:
  • Phone: 203-388-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number317619
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number1.080220
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: