Basic Information
| Provider Information | |||||||||
| NPI: | 1760927594 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANGULO | ||||||||
| FirstName: | MEGAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 512 NEW ENGLAND CT APT 302 | ||||||||
| Address2: | |||||||||
| City: | ALTAMONTE SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327142160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3057263322 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1775 W STATE ROAD 434 | ||||||||
| Address2: | |||||||||
| City: | LONGWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327505067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4079196845 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2017 | ||||||||
| LastUpdateDate: | 03/15/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | N | 103K00000X | 1-19-39704 | FL | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.