Provider Demographics
NPI:1740796382
Name:PELLOT, ANGEL DAVID
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:DAVID
Last Name:PELLOT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4285 SW MARTIN HWY
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-8615
Mailing Address - Country:US
Mailing Address - Phone:772-285-1144
Mailing Address - Fax:
Practice Address - Street 1:9151 SW 21ST DRIVE
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-7925
Practice Address - Country:US
Practice Address - Phone:772-285-1144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty