Provider Demographics
NPI:1194257758
Name:BAZEMORE QUAYE, ANGELA L (DBH, CFNC, RDMS, SAP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:L
Last Name:BAZEMORE QUAYE
Suffix:
Gender:
Credentials:DBH, CFNC, RDMS, SAP
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:L
Other - Last Name:BAZEMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DBH, CFNC, RDMS, SAP
Mailing Address - Street 1:29697 N 69TH DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-3178
Mailing Address - Country:US
Mailing Address - Phone:443-636-0686
Mailing Address - Fax:602-532-7857
Practice Address - Street 1:29697 N 69TH DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-3178
Practice Address - Country:US
Practice Address - Phone:443-636-0686
Practice Address - Fax:602-532-7857
Is Sole Proprietor?:No
Enumeration Date:2017-03-31
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X
MD1083952471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ814313295Medicaid
AZ814313295Medicaid
AZ814313295Medicare Oscar/Certification