Provider Demographics
NPI:1871181222
Name:MOODY, ANGELINA C
Entity Type:Individual
Prefix:MRS
First Name:ANGELINA
Middle Name:C
Last Name:MOODY
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 1:2795 MACDUFF DR NW
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-9505
Mailing Address - Country:US
Mailing Address - Phone:330-936-8338
Mailing Address - Fax:
Practice Address - Street 1:1409 16TH ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44703-1037
Practice Address - Country:US
Practice Address - Phone:330-936-8338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-31
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health