Healthcare Provider Details

I. General information

NPI: 1689961864
Provider Name (Legal Business Name): ANGELA CANDELARIA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2011
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 BEACH RD STE 105
FAIRFIELD CT
06824-6017
US

IV. Provider business mailing address

3300 S FISKE BLVD
ROCKLEDGE FL
32955-4306
US

V. Phone/Fax

Practice location:
  • Phone: 203-334-5959
  • Fax: 203-298-9035
Mailing address:
  • Phone: 321-434-9358
  • Fax: 321-951-7408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number054643
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME127307
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: