Provider Demographics
NPI:1053073379
Name:KALSTO, BRIAN THOMAS (PA-C)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:THOMAS
Last Name:KALSTO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-5327
Mailing Address - Country:US
Mailing Address - Phone:407-905-8827
Mailing Address - Fax:407-886-4282
Practice Address - Street 1:225 E 7TH ST
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-5327
Practice Address - Country:US
Practice Address - Phone:407-905-8827
Practice Address - Fax:407-886-4282
Is Sole Proprietor?:No
Enumeration Date:2021-10-13
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9114973363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant