Provider Demographics
NPI:1598026742
Name:FERNANDEZ, ANGELINA (MS ED TSHH)
Entity Type:Individual
Prefix:MS
First Name:ANGELINA
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:MS ED TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8515 67TH AVE
Mailing Address - Street 2:PRIVATE HOUSE
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-5213
Mailing Address - Country:US
Mailing Address - Phone:917-854-3490
Mailing Address - Fax:
Practice Address - Street 1:1301 5TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-3119
Practice Address - Country:US
Practice Address - Phone:212-426-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist