Healthcare Provider Details

I. General information

NPI: 1659944320
Provider Name (Legal Business Name): ANGELICA SZELLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2021
Last Update Date: 03/10/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 MAMARONECK AVE
WHITE PLAINS NY
10605-1310
US

IV. Provider business mailing address

3656 LEE RD
JEFFERSON VALLEY NY
10535-1512
US

V. Phone/Fax

Practice location:
  • Phone: 914-328-2020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5485
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: