Provider Demographics
NPI:1982459061
Name:MAVROS, ANGELIA FLETCHER
Entity Type:Individual
Prefix:
First Name:ANGELIA
Middle Name:FLETCHER
Last Name:MAVROS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1751 27TH ST S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33712-2645
Mailing Address - Country:US
Mailing Address - Phone:727-403-8111
Mailing Address - Fax:
Practice Address - Street 1:1751 27TH ST S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33712-2645
Practice Address - Country:US
Practice Address - Phone:727-403-8111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management