Provider Demographics
NPI:1689436164
Name:ANGELES, ESTEFANY (MS, CLC, LCCE)
Entity Type:Individual
Prefix:MRS
First Name:ESTEFANY
Middle Name:
Last Name:ANGELES
Suffix:
Gender:F
Credentials:MS, CLC, LCCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 KAPPOCK ST APT 5K
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-0684
Mailing Address - Country:US
Mailing Address - Phone:646-438-0070
Mailing Address - Fax:
Practice Address - Street 1:609 KAPPOCK ST APT 5K
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-0684
Practice Address - Country:US
Practice Address - Phone:646-438-0070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA353100174N00000X
NY374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RN