Healthcare Provider Details

I. General information

NPI: 1518586569
Provider Name (Legal Business Name): ANJELI SONG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2020
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 ABIGAIL LN
PORT MATILDA PA
16870-7153
US

IV. Provider business mailing address

100 N ACADEMY AVE
DANVILLE PA
17822-4903
US

V. Phone/Fax

Practice location:
  • Phone: 814-272-7100
  • Fax: 814-272-6519
Mailing address:
  • Phone: 814-272-7100
  • Fax: 814-272-6519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberME174303
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberMD490335C
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberC4585
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberC4585
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: