Healthcare Provider Details

I. General information

NPI: 1023506375
Provider Name (Legal Business Name): SHIVANI D'ANGELO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2018
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8333 N DAVIS HWY
PENSACOLA FL
32514-6050
US

IV. Provider business mailing address

8333 N DAVIS HWY
PENSACOLA FL
32514-6050
US

V. Phone/Fax

Practice location:
  • Phone: 850-474-8428
  • Fax: 850-969-2872
Mailing address:
  • Phone: 850-474-8428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME179173
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD61508006
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: