Healthcare Provider Details

I. General information

NPI: 1194445601
Provider Name (Legal Business Name): AMY MICHELE ANGELO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2022
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 GATSBY DR APT 1
RAYNHAM MA
02767-8073
US

IV. Provider business mailing address

52 GATSBY DR APT 1
RAYNHAM MA
02767-8073
US

V. Phone/Fax

Practice location:
  • Phone: 508-208-0552
  • Fax:
Mailing address:
  • Phone: 508-208-0552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN10047861
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: