Healthcare Provider Details

I. General information

NPI: 1285544973
Provider Name (Legal Business Name): CRYSTAL BEALE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17045 S DIXIE HWY
PALMETTO BAY FL
33157-4362
US

IV. Provider business mailing address

14520 SW 148TH CT
MIAMI FL
33196-2314
US

V. Phone/Fax

Practice location:
  • Phone: 305-232-2200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number4705
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: