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General NPI Number Information
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NPI Number | 1225769813
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Entity Type | Individual
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Provider Name | KRISLI ANDONI MS, PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/23/2022
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Last Update Date | 11/06/2025
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Provider Practice Location Address
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Address Line | 1400 VFW PKWY
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City | WEST ROXBURY
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State | MA
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Zip | 02132-4927
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Country | US
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Telephone | 857-203-3479
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Fax |
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Provider Business Mailing Address
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Address Line | 259 MACK AVE
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City | DETROIT
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State | MI
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Zip | 48201-2427
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Country | US
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Telephone | 586-214-8076
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 5601011183
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License Number State | MI
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