Healthcare Provider Details

I. General information

NPI: 1538331699
Provider Name (Legal Business Name): CHRISTINA AMY STREETS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINA AMY HALSTEAD MD

II. Dates (important events)

Enumeration Date: 03/28/2008
Last Update Date: 12/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1056 HOPE ST
PROVIDENCE RI
02906-5026
US

IV. Provider business mailing address

1892 STEUBEN DR
LANSDALE PA
19446-5436
US

V. Phone/Fax

Practice location:
  • Phone: 401-751-1235
  • Fax:
Mailing address:
  • Phone: 610-389-4009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number13655
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMD434234
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: