Provider Demographics
NPI:1003170267
Name:DEANGELIS, ADRIANNA (MSSPED)
Entity Type:Individual
Prefix:MRS
First Name:ADRIANNA
Middle Name:
Last Name:DEANGELIS
Suffix:
Gender:F
Credentials:MSSPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 ROLLING ST
Mailing Address - Street 2:
Mailing Address - City:MALVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11565-2340
Mailing Address - Country:US
Mailing Address - Phone:516-593-8549
Mailing Address - Fax:
Practice Address - Street 1:167 ROLLING ST
Practice Address - Street 2:
Practice Address - City:MALVERNE
Practice Address - State:NY
Practice Address - Zip Code:11565-2340
Practice Address - Country:US
Practice Address - Phone:516-593-8549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist