Healthcare Provider Details

I. General information

NPI: 1902716103
Provider Name (Legal Business Name): KRYSTAL CONNELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

367 BRISTOL ST APT 208
BROOKLYN NY
11212-6099
US

IV. Provider business mailing address

367 BRISTOL ST APT 208
BROOKLYN NY
11212-6099
US

V. Phone/Fax

Practice location:
  • Phone: 516-952-3025
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: