Provider Demographics
NPI:1639514748
Name:DAYSUDOVA, ANGELINA
Entity Type:Individual
Prefix:DR
First Name:ANGELINA
Middle Name:
Last Name:DAYSUDOVA
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 1:3656 MYKONOS CT
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-1295
Mailing Address - Country:US
Mailing Address - Phone:646-358-2322
Mailing Address - Fax:
Practice Address - Street 1:6000 GLADES RD STE 1116
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-7294
Practice Address - Country:US
Practice Address - Phone:561-367-1077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-02
Last Update Date:2023-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007841152W00000X
PA002654152W00000X
FLOPC5334152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist