Provider Demographics
NPI:1861854499
Name:STURDIVANT, ANGELA DENISE
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:DENISE
Last Name:STURDIVANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9715
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35220-0715
Mailing Address - Country:US
Mailing Address - Phone:205-401-7312
Mailing Address - Fax:
Practice Address - Street 1:1609 1ST ST NE
Practice Address - Street 2:
Practice Address - City:CENTER POINT
Practice Address - State:AL
Practice Address - Zip Code:35215-5603
Practice Address - Country:US
Practice Address - Phone:205-401-7312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1242741744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management