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General NPI Number Information
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NPI Number | 1659401594
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Entity Type | Individual
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Provider Name | LAURA JEANNE D'ANGELO M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 05/22/2014
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Provider Practice Location Address
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Address Line | 950 S. TAMIAMI TRAIL SUITE 103
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City | SARASOTA
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State | FL
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Zip | 34236
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Country | US
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Telephone | 941-302-2426
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Fax | 941-421-0102
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Provider Business Mailing Address
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Address Line | 950 S. TAMIAMI TRAIL SUITE 103
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City | SARASOTA
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State | FL
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Zip | 34236
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Country | US
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Telephone | 941-302-2426
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Fax | 941-421-0102
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD17729
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License Number State | TN
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