Provider Demographics
NPI:1689940595
Name:D'ANGELO, NICHOLAS (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:D'ANGELO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18610 NW 87TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-3518
Mailing Address - Country:US
Mailing Address - Phone:184-466-5482
Mailing Address - Fax:186-692-0058
Practice Address - Street 1:18610 NW 87TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-3518
Practice Address - Country:US
Practice Address - Phone:184-466-5482
Practice Address - Fax:186-692-0058
Is Sole Proprietor?:No
Enumeration Date:2012-03-25
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME121379207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine