Healthcare Provider Details

I. General information

NPI: 1801810858
Provider Name (Legal Business Name): ANGELIA H DOBRZYNSKI PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 ALYSHEBA WAY
LEXINGTON KY
40509-9023
US

IV. Provider business mailing address

PO BOX 950248
LOUISVILLE KY
40295-0248
US

V. Phone/Fax

Practice location:
  • Phone: 859-260-4530
  • Fax: 859-260-4530
Mailing address:
  • Phone: 502-489-5730
  • Fax: 502-489-5753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA401
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: