Provider Demographics
NPI:1710089073
Name:DEANGELO, ANITA (APRN, MSN)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:DEANGELO
Suffix:
Gender:F
Credentials:APRN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 POND HILL RD
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-5337
Mailing Address - Country:US
Mailing Address - Phone:203-269-8255
Mailing Address - Fax:
Practice Address - Street 1:3018 DIXWELL AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3508
Practice Address - Country:US
Practice Address - Phone:203-281-5910
Practice Address - Fax:203-288-0676
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001326363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
S79087Medicare UPIN
660000016Medicare ID - Type Unspecified