Provider Demographics
NPI:1073315982
Name:AEGLE RADIANT HEALTH, PLLC
Entity type:Organization
Organization Name:AEGLE RADIANT HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARDELLA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:443-306-8940
Mailing Address - Street 1:4 UNION PARK RD STE 20
Mailing Address - Street 2:
Mailing Address - City:TOPSHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04086-1711
Mailing Address - Country:US
Mailing Address - Phone:207-656-5725
Mailing Address - Fax:
Practice Address - Street 1:4 UNION PARK RD STE 20
Practice Address - Street 2:
Practice Address - City:TOPSHAM
Practice Address - State:ME
Practice Address - Zip Code:04086-1711
Practice Address - Country:US
Practice Address - Phone:207-656-5725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty