Provider Demographics
NPI:1003178161
Name:MAZZEO, ANGELA M (MSED)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:M
Last Name:MAZZEO
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1967 HANCOCK AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-1514
Mailing Address - Country:US
Mailing Address - Phone:917-576-6884
Mailing Address - Fax:
Practice Address - Street 1:1967 HANCOCK AVE
Practice Address - Street 2:
Practice Address - City:NORTH BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-1514
Practice Address - Country:US
Practice Address - Phone:917-576-6884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY851521174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY851521OtherCERTIFICATIONS