Provider Demographics
NPI:1225887110
Name:DANGELO, MEGAN JUDITH
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:JUDITH
Last Name:DANGELO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:JUDITH
Other - Last Name:SHOULER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:249 CLASSON AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-1440
Mailing Address - Country:US
Mailing Address - Phone:347-666-3458
Mailing Address - Fax:
Practice Address - Street 1:249 CLASSON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-1440
Practice Address - Country:US
Practice Address - Phone:984-400-1081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013724101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health