Provider Demographics
NPI:1578831657
Name:NEEQUAYE, ANGELA
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:NEEQUAYE
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 1:1978 UNIVERSITY BLVD
Mailing Address - Street 2:APT 4N
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-4454
Mailing Address - Country:US
Mailing Address - Phone:347-694-9042
Mailing Address - Fax:
Practice Address - Street 1:1978 UNIVERSITY BLVD
Practice Address - Street 2:APT 4N
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-4454
Practice Address - Country:US
Practice Address - Phone:347-694-9042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY288827164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse