Healthcare Provider Details

I. General information

NPI: 1003582347
Provider Name (Legal Business Name): KRISTIN KAZZI PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KRIS KAZZI PA-C

II. Dates (important events)

Enumeration Date: 08/17/2021
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 MONTVALE AVE
STONEHAM MA
02180-3647
US

IV. Provider business mailing address

54 WILMOT ST APT 1
LAWRENCE MA
01841-2646
US

V. Phone/Fax

Practice location:
  • Phone: 617-500-2669
  • Fax:
Mailing address:
  • Phone: 978-382-3544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: