Provider Demographics
NPI:1194052563
Name:LALLA, ANGELA M (AUD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:LALLA
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:M
Other - Last Name:MISKINIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:44 HATHORN BLVD.
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866
Mailing Address - Country:US
Mailing Address - Phone:518-581-7408
Mailing Address - Fax:518-671-1490
Practice Address - Street 1:318 RIDGE STREET
Practice Address - Street 2:
Practice Address - City:GLENS SALLAS
Practice Address - State:NY
Practice Address - Zip Code:12801
Practice Address - Country:US
Practice Address - Phone:518-581-7408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001117-1231H00000X
NY14000002755237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter