MEDICARE: DR. KRISTIN WIENEKE MALATINO PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PY9168	FL
2	103T00000X	Psychologist	9669	MA

General Provider Information

NPI Number	:	1992994263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTIN WIENEKE MALATINO PH.D.

Provider Business Mailing Address
First Line	:	8976 CONROY WINDERMERE RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-3128
Country	:	US
Telephone Number	:	407-605-5035
Fax Number	:

Provider Business Practice Location Address
First Line	:	8976 CONROY WINDERMERE RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-3128
Country	:	US
Telephone Number	:	407-605-5035
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2007
Last Update Date	:	11/17/2016

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