Provider Demographics
NPI:1700203288
Name:PEELE, ANGELLA MAURINE
Entity Type:Individual
Prefix:MS
First Name:ANGELLA
Middle Name:MAURINE
Last Name:PEELE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANGELLA
Other - Middle Name:MAURINE
Other - Last Name:PEELE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:1015 FAIRFIELD AVE
Mailing Address - Street 2:APT C5
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06605-1139
Mailing Address - Country:US
Mailing Address - Phone:347-932-6061
Mailing Address - Fax:
Practice Address - Street 1:1150 TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472-4707
Practice Address - Country:US
Practice Address - Phone:347-932-6061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY317962164W00000X
CT0384898376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No376K00000XNursing Service Related ProvidersNurse's Aide