Provider Demographics
NPI:1407032477
Name:KANDEL, KRISTA JAHNKE (MD)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:JAHNKE
Last Name:KANDEL
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 1:736 IRVING AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1690
Mailing Address - Country:US
Mailing Address - Phone:315-470-7311
Mailing Address - Fax:315-470-2693
Practice Address - Street 1:736 IRVING AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1687
Practice Address - Country:US
Practice Address - Phone:315-470-7311
Practice Address - Fax:315-470-2693
Is Sole Proprietor?:No
Enumeration Date:2008-01-21
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN5755207P00000X
NY289070-1207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine