Healthcare Provider Details

I. General information

NPI: 1215619895
Provider Name (Legal Business Name): ANGELO SISOFO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2023
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S COLLEGE AVE
NEWARK DE
19716-2000
US

IV. Provider business mailing address

25 HAGGIS RD
MIDDLETOWN DE
19709-8753
US

V. Phone/Fax

Practice location:
  • Phone: 302-831-2258
  • Fax:
Mailing address:
  • Phone: 302-883-7599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberJ3-0010973
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: