Provider Demographics
NPI:1275723116
Name:SHILLING, ANGELA ROXANNE (CST/SFA)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:ROXANNE
Last Name:SHILLING
Suffix:
Gender:F
Credentials:CST/SFA
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:ROXANNE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CST/SFA
Mailing Address - Street 1:1333 IRISHMOSS TRL
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-3885
Mailing Address - Country:US
Mailing Address - Phone:512-912-6677
Mailing Address - Fax:
Practice Address - Street 1:1333 IRISHMOSS TRL
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-3885
Practice Address - Country:US
Practice Address - Phone:512-912-6677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
072417246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist