Provider Demographics
NPI:1427291046
Name:IRIZARRY, KRYSTAL ANDREA (MD)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:ANDREA
Last Name:IRIZARRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 LEE RD STE 170
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2167
Mailing Address - Country:US
Mailing Address - Phone:407-896-2901
Mailing Address - Fax:407-896-2902
Practice Address - Street 1:1801 LEE RD STE 170
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2167
Practice Address - Country:US
Practice Address - Phone:407-896-2901
Practice Address - Fax:407-896-2902
Is Sole Proprietor?:No
Enumeration Date:2009-04-13
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2870252080P0205X
FLME1407682080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04698688Medicaid