Healthcare Provider Details

I. General information

NPI: 1043406150
Provider Name (Legal Business Name): ANGELA GIANCOLA WEATHERALL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA GIANCOLA M.D.

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6298 LINTON BLVD STE 100
DELRAY BEACH FL
33484-6444
US

IV. Provider business mailing address

PO BOX 13834
TALLAHASSEE FL
32317-3834
US

V. Phone/Fax

Practice location:
  • Phone: 561-800-3550
  • Fax: 561-621-8850
Mailing address:
  • Phone: 850-205-6232
  • Fax: 855-975-0615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME108749
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number245993
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: