Provider Demographics
NPI:1679726954
Name:D'ANGELO, ANDREA MARIE (MED, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARIE
Last Name:D'ANGELO
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11830 GRACES WAY
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6313
Mailing Address - Country:US
Mailing Address - Phone:412-860-5366
Mailing Address - Fax:
Practice Address - Street 1:11830 GRACES WAY
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-6313
Practice Address - Country:US
Practice Address - Phone:412-860-5366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA11423235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist