Provider Demographics
NPI:1205056827
Name:FEDELE, CRYSTAL CRICKETTE (AP)
Entity type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:CRICKETTE
Last Name:FEDELE
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:CRICKETTE
Other - Last Name:MAPLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AP, DOM
Mailing Address - Street 1:3230 S RIDGEWOOD AVE APT 2408
Mailing Address - Street 2:
Mailing Address - City:SOUTH DAYTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32119-3528
Mailing Address - Country:US
Mailing Address - Phone:386-795-0717
Mailing Address - Fax:
Practice Address - Street 1:3230 S RIDGEWOOD AVE APT 2408
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-3528
Practice Address - Country:US
Practice Address - Phone:386-795-0717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2080(FL)171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist