Provider Demographics
NPI:1427191733
Name:D'ANGELO, SALLY M (MD)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:M
Last Name:D'ANGELO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1518 GIRARD BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-1823
Mailing Address - Country:US
Mailing Address - Phone:505-266-3835
Mailing Address - Fax:505-266-3340
Practice Address - Street 1:1518 GIRARD BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-1823
Practice Address - Country:US
Practice Address - Phone:505-266-3835
Practice Address - Fax:505-266-3340
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2012-08-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM93-246208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM21127Medicaid