Provider Demographics
NPI:1811297427
Name:SABRY, ANGELA W (MD)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:W
Last Name:SABRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 HERNDON AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93611-6317
Mailing Address - Country:US
Mailing Address - Phone:559-494-4446
Mailing Address - Fax:
Practice Address - Street 1:1069 E CHAMPLAIN DR STE A
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-4223
Practice Address - Country:US
Practice Address - Phone:559-494-4446
Practice Address - Fax:559-494-4446
Is Sole Proprietor?:No
Enumeration Date:2010-10-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA117534207K00000X, 207KA0200X
CO51467208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1811297427Medicaid
CAZZZZ21572ZOtherMCARE PTAN FOR GROUP
CO48576239Medicaid
CAZZZZ21572ZOtherMCARE PTAN FOR GROUP
CA1811297427Medicaid