Healthcare Provider Details

I. General information

NPI: 1710818653
Provider Name (Legal Business Name): ANGELEE ALFONSO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 W 56TH ST
HIALEAH FL
33012
US

IV. Provider business mailing address

295 W 56TH ST
HIALEAH FL
33012
US

V. Phone/Fax

Practice location:
  • Phone: 305-290-9066
  • Fax:
Mailing address:
  • Phone: 305-290-9066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberAPRN11047172
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: