Healthcare Provider Details

I. General information

NPI: 1922125640
Provider Name (Legal Business Name): KRISTJAN OLAFSSON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 02/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 S KIRKMAN RD STE 680
ORLANDO FL
32819-7911
US

IV. Provider business mailing address

9208 HIDDEN BAY LN
ORLANDO FL
32819-4859
US

V. Phone/Fax

Practice location:
  • Phone: 866-284-0211
  • Fax:
Mailing address:
  • Phone: 407-765-5141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY6548
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: