MEDICARE: DEIRDRE FIONNA ANGELASTRO FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	R209417	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	R209417	OTHER	MD	STATE LICENSE

General Provider Information

NPI Number	:	1710333281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEIRDRE FIONNA ANGELASTRO FNP

Provider Business Mailing Address
First Line	:	12347 SOUR CHERRY WAY
Second Line	:
City	:	NORTH POTOMAC
State	:	MD
Zip	:	20878-4748
Country	:	US
Telephone Number	:	301-337-8610
Fax Number	:	301-337-8621

Provider Business Practice Location Address
First Line	:	7505 DEMOCRACY BLVD APT A113
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20817-1238
Country	:	US
Telephone Number	:	301-337-8610
Fax Number	:	301-337-8621

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2016
Last Update Date	:	02/02/2026

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