MEDICARE: RENATA ANGELINI MD

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	2084P0800X	Psychiatry Physician	MD438118	PA
2	2084P0800X	Psychiatry Physician	ME124620	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720249030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENATA ANGELINI MD

Provider Business Mailing Address
First Line	:	540 NW UNIVERSITY BLVD STE 203
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34986-2281
Country	:	US
Telephone Number	:	754-212-4625
Fax Number	:	754-212-4630

Provider Business Practice Location Address
First Line	:	540 NW UNIVERSITY BLVD STE 203
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34986-2281
Country	:	US
Telephone Number	:	754-212-4625
Fax Number	:	754-212-4630

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

Provider Enumeration Date	:	06/19/2008
Last Update Date	:	08/07/2024

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Directions to “ RENATA ANGELINI MD” Practice Location

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