Provider Demographics
NPI:1457738866
Name:KANELIDIS, ANGELO JOHN (HAS)
Entity type:Individual
Prefix:MR
First Name:ANGELO
Middle Name:JOHN
Last Name:KANELIDIS
Suffix:
Gender:M
Credentials:HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2831 N FEDERAL HWY STE 11
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6809
Mailing Address - Country:US
Mailing Address - Phone:561-931-3145
Mailing Address - Fax:561-931-3148
Practice Address - Street 1:2831 N FEDERAL HWY STE 11
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6809
Practice Address - Country:US
Practice Address - Phone:561-931-3145
Practice Address - Fax:561-931-3148
Is Sole Proprietor?:No
Enumeration Date:2015-05-05
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS5034237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist