Provider Demographics
NPI:1770967432
Name:STAVRO, ANGELINA (MSED)
Entity type:Individual
Prefix:MRS
First Name:ANGELINA
Middle Name:
Last Name:STAVRO
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 1:2408 E 4TH ST
Mailing Address - Street 2:APT. 1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-5426
Mailing Address - Country:US
Mailing Address - Phone:646-462-0007
Mailing Address - Fax:
Practice Address - Street 1:2408 E 4TH ST
Practice Address - Street 2:APT. 1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-5426
Practice Address - Country:US
Practice Address - Phone:646-462-0007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist