Provider Demographics
NPI:1861989980
Name:SCIACCA, ANGELA (MED)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:SCIACCA
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:THERIAULT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1009 WOODLANDS CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-5251
Mailing Address - Country:US
Mailing Address - Phone:315-529-2927
Mailing Address - Fax:
Practice Address - Street 1:1009 WOODLANDS CREEK WAY
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-5251
Practice Address - Country:US
Practice Address - Phone:315-529-2927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-14
Last Update Date:2018-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist