Provider Demographics
NPI:1063459865
Name:AMOAKO, ANGELA (PA)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:
Last Name:AMOAKO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22307 114TH AVE
Mailing Address - Street 2:CAMBRIA HEIGHTS
Mailing Address - City:CAMBRIA HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11411-1218
Mailing Address - Country:US
Mailing Address - Phone:718-217-8431
Mailing Address - Fax:
Practice Address - Street 1:1783 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-4537
Practice Address - Country:US
Practice Address - Phone:212-348-6001
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003303363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical