Provider Demographics
NPI:1033281464
Name:D ANGELO, RONALD M (MS CCC-A)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:M
Last Name:D ANGELO
Suffix:
Gender:M
Credentials:MS CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 406153
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-1876
Mailing Address - Country:US
Mailing Address - Phone:585-227-9920
Mailing Address - Fax:585-225-6574
Practice Address - Street 1:121 ERIE CANAL DR
Practice Address - Street 2:STE. E
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4605
Practice Address - Country:US
Practice Address - Phone:585-227-9920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001993231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
11545677OtherCAQH
NY179756AIOtherPREFERRED CARE
NYP010001993OtherEXCELLUS ROCHESTER REGION
11545677OtherCAQH