Provider Demographics
NPI:1386462869
Name:D'ANGELO, RILEY (PA-C)
Entity type:Individual
Prefix:
First Name:RILEY
Middle Name:
Last Name:D'ANGELO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3622 CORAL WAY APT 710
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-3286
Mailing Address - Country:US
Mailing Address - Phone:814-215-0938
Mailing Address - Fax:
Practice Address - Street 1:8100 OAK LN STE 400
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-5876
Practice Address - Country:US
Practice Address - Phone:305-888-0929
Practice Address - Fax:305-888-4044
Is Sole Proprietor?:No
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9119279363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical