Provider Demographics
NPI:1730910837
Name:VANGELENA, AUSTIN ALI (MD)
Entity type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:ALI
Last Name:VANGELENA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:AUSTIN
Other - Middle Name:ALI
Other - Last Name:VANGELENA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, MS-CMHC, MHA
Mailing Address - Street 1:114 12TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEAIR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33786-3302
Mailing Address - Country:US
Mailing Address - Phone:928-955-9522
Mailing Address - Fax:
Practice Address - Street 1:14506 UNIVERSITY POINT PL
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-5425
Practice Address - Country:US
Practice Address - Phone:813-971-8311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-10
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty