MEDICARE: MAYELING ANGELASTRO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	IMH 12275	FL
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1164830162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYELING ANGELASTRO

Provider Business Mailing Address
First Line	:	7807 SUGAR BROOK CT
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-7210
Country	:	US
Telephone Number	:	720-508-0227
Fax Number	:

Provider Business Practice Location Address
First Line	:	7807 SUGAR BROOK CT
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-7210
Country	:	US
Telephone Number	:	720-508-0227
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2014
Last Update Date	:	10/10/2016

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Directions to “ MAYELING ANGELASTRO ” Practice Location

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