Provider Demographics
NPI:1447602719
Name:ALANDETE, ANGELICA MARIA
Entity Type:Individual
Prefix:MS
First Name:ANGELICA
Middle Name:MARIA
Last Name:ALANDETE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 FULTON ST
Mailing Address - Street 2:502
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-2636
Mailing Address - Country:US
Mailing Address - Phone:718-852-5470
Mailing Address - Fax:718-852-6972
Practice Address - Street 1:1360 FULTON ST
Practice Address - Street 2:502
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-2636
Practice Address - Country:US
Practice Address - Phone:718-852-5470
Practice Address - Fax:718-852-6972
Is Sole Proprietor?:No
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY878456820171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator