Provider Demographics
NPI:1184356859
Name:CIROALO, ANGELA (LDN)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:CIROALO
Suffix:
Gender:F
Credentials:LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5552 MALT DR APT 4
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-4658
Mailing Address - Country:US
Mailing Address - Phone:732-492-6691
Mailing Address - Fax:
Practice Address - Street 1:5552 MALT DR APT 4
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-4658
Practice Address - Country:US
Practice Address - Phone:732-492-6691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10990133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist