Healthcare Provider Details

I. General information

NPI: 1770498560
Provider Name (Legal Business Name): KRYSTAL MACHADO PINTO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 VONDERBURG DR STE 201
BRANDON FL
33511-5900
US

IV. Provider business mailing address

403 LAKEWOOD AVE
TAMPA FL
33613-1830
US

V. Phone/Fax

Practice location:
  • Phone: 813-653-1149
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI8872
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: