Provider Demographics
NPI:1578349056
Name:SZCZERBIAK, ANGELA MARIA (RD)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MARIA
Last Name:SZCZERBIAK
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:MARIA
Other - Last Name:SZCZERBIAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:5546 W ROOSEVELT ST STE 1
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85043-2608
Mailing Address - Country:US
Mailing Address - Phone:602-352-0724
Mailing Address - Fax:
Practice Address - Street 1:5546 W ROOSEVELT ST STE 1
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85043-2608
Practice Address - Country:US
Practice Address - Phone:602-352-0724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.007817133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, RenalGroup - Single Specialty