1679823546 NPI number — KRISTIE SCALDONE CSA

Table of content: KRISTIE SCALDONE CSA (NPI 1679823546)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679823546 NPI number — KRISTIE SCALDONE CSA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCALDONE
Provider First Name:
KRISTIE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CSA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679823546
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
749 GRIMES BRIDGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSWELL
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30075-4614
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-985-4257
Provider Business Mailing Address Fax Number:
770-985-4258

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
749 GRIMES BRIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSWELL
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30075-4614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-985-4257
Provider Business Practice Location Address Fax Number:
770-985-4258
Provider Enumeration Date:
09/18/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  61477 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AS0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 246ZC0007X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 800806828 . This is a "TAX ID #" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".