Provider Demographics
NPI:1720249030
Name:ANGELINI, RENATA (MD)
Entity type:Individual
Prefix:
First Name:RENATA
Middle Name:
Last Name:ANGELINI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 NW UNIVERSITY BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-2281
Mailing Address - Country:US
Mailing Address - Phone:754-212-4625
Mailing Address - Fax:754-212-4630
Practice Address - Street 1:540 NW UNIVERSITY BLVD STE 203
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-2281
Practice Address - Country:US
Practice Address - Phone:754-212-4625
Practice Address - Fax:754-212-4630
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4381182084P0800X
FLME1246202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry