Provider Demographics
NPI:1669010419
Name:ANGELO, STACY DIANE (CDCA)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:DIANE
Last Name:ANGELO
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:DIANE
Other - Last Name:ANGELO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:73621 RESERVOIR HILL RD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:OH
Mailing Address - Zip Code:43977-9785
Mailing Address - Country:US
Mailing Address - Phone:740-359-0495
Mailing Address - Fax:
Practice Address - Street 1:73621 RESERVOIR HILL RD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:OH
Practice Address - Zip Code:43977-9785
Practice Address - Country:US
Practice Address - Phone:740-359-0495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator