Healthcare Provider Details

I. General information

NPI: 1619145075
Provider Name (Legal Business Name): KRISTA BAILEY MANGANIELLO M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2008
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2479 ALOMA AVE
WINTER PARK FL
32792-2541
US

IV. Provider business mailing address

8297 WESTCOTT SHORE DR
ORLANDO FL
32829-7682
US

V. Phone/Fax

Practice location:
  • Phone: 407-657-6692
  • Fax:
Mailing address:
  • Phone: 407-595-1619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH13097
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberMH13097
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: