Provider Demographics
NPI:1922125640
Name:OLAFSSON, KRISTJAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:KRISTJAN
Middle Name:
Last Name:OLAFSSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9208 HIDDEN BAY LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-4859
Mailing Address - Country:US
Mailing Address - Phone:407-765-5141
Mailing Address - Fax:
Practice Address - Street 1:5401 S KIRKMAN RD STE 680
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7911
Practice Address - Country:US
Practice Address - Phone:866-284-0211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103G00000X
FLPY6548103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
54788Medicare ID - Type Unspecified