Healthcare Provider Details

I. General information

NPI: 1245876911
Provider Name (Legal Business Name): ANGELICA CELESTE DELIA MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2019
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23160 MOAKLEY ST
LEONARDTOWN MD
20650-2922
US

IV. Provider business mailing address

45812 NICHOLAS CT
GREAT MILLS MD
20634-3401
US

V. Phone/Fax

Practice location:
  • Phone: 301-475-5511
  • Fax:
Mailing address:
  • Phone: 440-454-3865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number12061
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: