Provider Demographics
NPI:1881214245
Name:ST ANGE, AMELIA CASANDRA FRITZI (MD)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:CASANDRA FRITZI
Last Name:ST ANGE
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 1:4998 10TH AVE N
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-2210
Mailing Address - Country:US
Mailing Address - Phone:561-293-2900
Mailing Address - Fax:561-412-5554
Practice Address - Street 1:4998 10TH AVE N
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-2210
Practice Address - Country:US
Practice Address - Phone:561-293-2900
Practice Address - Fax:561-412-5554
Is Sole Proprietor?:No
Enumeration Date:2020-04-25
Last Update Date:2024-10-07
Deactivation Date:2022-01-10
Deactivation Code:
Reactivation Date:2022-02-02
Provider Licenses
StateLicense IDTaxonomies
FLME166119207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine