Provider Demographics
NPI:1710333281
Name:ANGELASTRO, DEIRDRE FIONNA (FNP)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:FIONNA
Last Name:ANGELASTRO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4938 SAINT ELMO AVE
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-6008
Mailing Address - Country:US
Mailing Address - Phone:301-337-8610
Mailing Address - Fax:301-337-8621
Practice Address - Street 1:4938 SAINT ELMO AVE
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-6008
Practice Address - Country:US
Practice Address - Phone:301-337-8610
Practice Address - Fax:301-337-8621
Is Sole Proprietor?:No
Enumeration Date:2016-05-13
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR209417363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR209417OtherSTATE LICENSE