Provider Demographics
NPI:1578738290
Name:FISCHER, ANGELA DIANE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:DIANE
Last Name:FISCHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANGELA
Other - Middle Name:DIANE
Other - Last Name:SHELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2221 TOWN CENTER AVE STE 121
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-6102
Mailing Address - Country:US
Mailing Address - Phone:321-456-5665
Mailing Address - Fax:
Practice Address - Street 1:2221 TOWN CENTER AVE STE 121
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-6102
Practice Address - Country:US
Practice Address - Phone:321-456-5665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82457207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology