Healthcare Provider Details

I. General information

NPI: 1346010055
Provider Name (Legal Business Name): ISABELLE ANGELINI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2024
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST
BOSTON MA
02115-6110
US

IV. Provider business mailing address

19 FOSTER ST
WORCESTER MA
01608-1715
US

V. Phone/Fax

Practice location:
  • Phone: 617-525-9733
  • Fax:
Mailing address:
  • Phone: 508-373-5607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number102609
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number23.006954
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: