Provider Demographics
NPI:1699110924
Name:ANGELONI, TIFFANY (RDO)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:ANGELONI
Suffix:
Gender:F
Credentials:RDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 BAKER AVENUE EXTENSION
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742
Mailing Address - Country:US
Mailing Address - Phone:978-287-9498
Mailing Address - Fax:978-287-9453
Practice Address - Street 1:86 BAKER AVENUE EXT
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2132
Practice Address - Country:US
Practice Address - Phone:978-287-9498
Practice Address - Fax:978-287-9453
Is Sole Proprietor?:No
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6289156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician