Provider Demographics
NPI:1003388281
Name:CRAIG, LYSSETTE KELLY
Entity Type:Individual
Prefix:MRS
First Name:LYSSETTE
Middle Name:KELLY
Last Name:CRAIG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7764 ANDORA DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-4753
Mailing Address - Country:US
Mailing Address - Phone:304-703-2644
Mailing Address - Fax:
Practice Address - Street 1:7764 ANDORA DR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238-4753
Practice Address - Country:US
Practice Address - Phone:304-703-2644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-27
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home