Provider Demographics
NPI:1598722431
Name:SMITH, ANGELA LYNN (DO)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:LYNN
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:68 SOUTH SERVICE ROAD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747
Mailing Address - Country:US
Mailing Address - Phone:516-945-3347
Mailing Address - Fax:516-945-3131
Practice Address - Street 1:100 GREAT MEADOW RD
Practice Address - Street 2:SUITE 208
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-2355
Practice Address - Country:US
Practice Address - Phone:860-563-0700
Practice Address - Fax:860-563-0741
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT044045207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology