Provider Demographics
NPI:1215619895
Name:SISOFO, ANGELO
Entity type:Individual
Prefix:
First Name:ANGELO
Middle Name:
Last Name:SISOFO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 HAGGIS RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-8753
Mailing Address - Country:US
Mailing Address - Phone:302-883-7599
Mailing Address - Fax:
Practice Address - Street 1:621 S COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19716-2000
Practice Address - Country:US
Practice Address - Phone:302-831-2258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program