1649489360 NPI number — DR. VICTORIA DIANE D'ANGELO SR. PSYD

Table of content: DR. VICTORIA DIANE D'ANGELO SR. PSYD (NPI 1649489360)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649489360 NPI number — DR. VICTORIA DIANE D'ANGELO SR. PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
D'ANGELO
Provider First Name:
VICTORIA
Provider Middle Name:
DIANE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
SR.
Provider Credential Text:
PSYD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649489360
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/26/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 VALLEY RD
Provider Second Line Business Mailing Address:
UNIT A201
Provider Business Mailing Address City Name:
MELROSE PARK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19027-3228
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-670-5954
Provider Business Mailing Address Fax Number:
215-546-1633

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 VALLEY RD
Provider Second Line Business Practice Location Address:
UNIT A201
Provider Business Practice Location Address City Name:
MELROSE PARK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19027-3228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-670-5954
Provider Business Practice Location Address Fax Number:
215-546-1633
Provider Enumeration Date:
05/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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