Healthcare Provider Details

I. General information

NPI: 1659682623
Provider Name (Legal Business Name): ANGELA DAGROSA AYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2010
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 JUPITER LAKES BLVD SUITE 2322D
JUPITER FL
33458-7102
US

IV. Provider business mailing address

326 JUPITER LAKES BLVD SUITE 2322D
JUPITER FL
33458-7102
US

V. Phone/Fax

Practice location:
  • Phone: 561-743-6245
  • Fax:
Mailing address:
  • Phone: 561-301-6442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA33895
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code246ZG1000X
TaxonomyMedical Geneticist (PhD) Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: