Provider Demographics
NPI:1558089847
Name:COON, CRISTA LYNN
Entity type:Individual
Prefix:
First Name:CRISTA
Middle Name:LYNN
Last Name:COON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CRISTA
Other - Middle Name:LYNN
Other - Last Name:CHIARAMONTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:50 CLOVER CROSSINGS
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14504-9782
Mailing Address - Country:US
Mailing Address - Phone:607-731-6144
Mailing Address - Fax:
Practice Address - Street 1:10456 SALTER RD
Practice Address - Street 2:
Practice Address - City:NORTH ROSE
Practice Address - State:NY
Practice Address - Zip Code:14516-9708
Practice Address - Country:US
Practice Address - Phone:315-587-4005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1156908174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist