Provider Demographics
NPI:1225027485
Name:COLANGELO, DAPHNE A (PAC)
Entity Type:Individual
Prefix:
First Name:DAPHNE
Middle Name:A
Last Name:COLANGELO
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 W GALENA BLVD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-4305
Mailing Address - Country:US
Mailing Address - Phone:630-897-2848
Mailing Address - Fax:630-897-4498
Practice Address - Street 1:1901 W GALENA BLVD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-4305
Practice Address - Country:US
Practice Address - Phone:630-897-2848
Practice Address - Fax:630-897-4498
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085001471363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
214706035Medicare PIN
212210036Medicare PIN