Provider Demographics
NPI:1144411455
Name:ANGEL, SHIRLEY G (OD)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:G
Last Name:ANGEL
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:1 TETERBORO LANDING DR
Mailing Address - Street 2:INSIDE WALMART VISION CENTER
Mailing Address - City:TETERBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07608
Mailing Address - Country:US
Mailing Address - Phone:201-375-4005
Mailing Address - Fax:201-288-4069
Practice Address - Street 1:1 TETERBORO LANDING DR
Practice Address - Street 2:INSIDE WALMART VISION CENTER
Practice Address - City:TETERBORO
Practice Address - State:NJ
Practice Address - Zip Code:07608
Practice Address - Country:US
Practice Address - Phone:201-375-4005
Practice Address - Fax:201-288-4069
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ27OA00595000152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist