Healthcare Provider Details

I. General information

NPI: 1366867673
Provider Name (Legal Business Name): CHRISTINA DEANGELIS LP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2014
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5340 PLYMOUTH RD STE 104
ANN ARBOR MI
48105-9557
US

IV. Provider business mailing address

5340 PLYMOUTH RD STE 104
ANN ARBOR MI
48105-9557
US

V. Phone/Fax

Practice location:
  • Phone: 734-263-1149
  • Fax:
Mailing address:
  • Phone: 734-263-1149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301015821
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: