Healthcare Provider Details

I. General information

NPI: 1679486658
Provider Name (Legal Business Name): ANGELA KAY AFFOLTER CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 WERTZ AVE NW
CANTON OH
44708-4171
US

IV. Provider business mailing address

12140 SHERMAN CHURCH RD NE
BOLIVAR OH
44612-8517
US

V. Phone/Fax

Practice location:
  • Phone: 234-214-8470
  • Fax:
Mailing address:
  • Phone: 360-632-5092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: