Provider Demographics
NPI:1861299257
Name:ACCOMANDO, ANGELA
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:
Last Name:ACCOMANDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 E RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HAVERSTRAW
Mailing Address - State:NY
Mailing Address - Zip Code:10993-1215
Mailing Address - Country:US
Mailing Address - Phone:845-728-5578
Mailing Address - Fax:
Practice Address - Street 1:73 E RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:WEST HAVERSTRAW
Practice Address - State:NY
Practice Address - Zip Code:10993-1215
Practice Address - Country:US
Practice Address - Phone:845-728-5578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174200000X, 332U00000X
335G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals
No174200000XOther Service ProvidersMeals
No335G00000XSuppliersMedical Foods Supplier