Provider Demographics
NPI:1174003974
Name:ANGELIDIS, AMBER SKY (NP)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:SKY
Last Name:ANGELIDIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 HIOAKS RD
Mailing Address - Street 2:STE B
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4072
Mailing Address - Country:US
Mailing Address - Phone:757-316-5800
Mailing Address - Fax:757-534-5190
Practice Address - Street 1:16 DELFAE DR
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:VA
Practice Address - Zip Code:22572-4281
Practice Address - Country:US
Practice Address - Phone:804-333-6400
Practice Address - Fax:804-333-3796
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001226435363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily