Provider Demographics
NPI:1659401594
Name:D'ANGELO, LAURA JEANNE (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:JEANNE
Last Name:D'ANGELO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 S. TAMIAMI TRAIL
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236
Mailing Address - Country:US
Mailing Address - Phone:941-302-2426
Mailing Address - Fax:941-421-0102
Practice Address - Street 1:950 S. TAMIAMI TRAIL
Practice Address - Street 2:SUITE 103
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236
Practice Address - Country:US
Practice Address - Phone:941-302-2426
Practice Address - Fax:941-421-0102
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD177292084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003349200Medicaid