Provider Demographics
NPI:1841694668
Name:SALANDANAN, KRYSTEL (PSYD)
Entity type:Individual
Prefix:
First Name:KRYSTEL
Middle Name:
Last Name:SALANDANAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 E SHORE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-2410
Mailing Address - Country:US
Mailing Address - Phone:516-466-7077
Mailing Address - Fax:
Practice Address - Street 1:310 E SHORE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023-2410
Practice Address - Country:US
Practice Address - Phone:516-466-7077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-22
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020951103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical