Provider Demographics
NPI:1053910406
Name:DOWLATRAM, ANGELLINA NICOLE
Entity type:Individual
Prefix:
First Name:ANGELLINA
Middle Name:NICOLE
Last Name:DOWLATRAM
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 1:2134 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-5315
Mailing Address - Country:US
Mailing Address - Phone:954-665-3620
Mailing Address - Fax:
Practice Address - Street 1:144 NW 37TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33127-3111
Practice Address - Country:US
Practice Address - Phone:305-767-1924
Practice Address - Fax:305-673-5917
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-17
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No101Y00000XBehavioral Health & Social Service ProvidersCounselor