Provider Demographics
NPI:1548957715
Name:DAZZELL, KRYSTLE ALANA (MBBS)
Entity type:Individual
Prefix:MS
First Name:KRYSTLE
Middle Name:ALANA
Last Name:DAZZELL
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 MAIN ST SUITE 206
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460
Mailing Address - Country:US
Mailing Address - Phone:610-983-1010
Mailing Address - Fax:
Practice Address - Street 1:824 MAIN ST SUITE 206
Practice Address - Street 2:INTERNAL MEDICINE
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460
Practice Address - Country:US
Practice Address - Phone:610-983-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-19
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program