Healthcare Provider Details

I. General information

NPI: 1811428576
Provider Name (Legal Business Name): KRISTINA MCINTYRE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2017
Last Update Date: 03/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1858 N ALAFAYA TRL STE 207
ORLANDO FL
32826-4754
US

IV. Provider business mailing address

PO BOX 6060
JENSEN BEACH FL
34957-0001
US

V. Phone/Fax

Practice location:
  • Phone: 407-900-5313
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ8003
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: