Provider Demographics
NPI:1871553966
Name:MACALLISTER, ANGELA MONACO (AUD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MONACO
Last Name:MACALLISTER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1561 LONG POND RD
Mailing Address - Street 2:SUITE 411
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4117
Mailing Address - Country:US
Mailing Address - Phone:585-723-0030
Mailing Address - Fax:585-723-8478
Practice Address - Street 1:1561 LONG POND RD
Practice Address - Street 2:SUITE 411
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4117
Practice Address - Country:US
Practice Address - Phone:585-723-0030
Practice Address - Fax:585-723-8478
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001928-1231H00000X, 231HA2400X, 231HA2500X
NY14000017710237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP010101928OtherEXCELLUS BCBS
NYP020101928OtherEXCELLUS BCBS
NY155524AIOtherPREFERRED CARE
NY510527691OtherEMPIRE PLAN
NY7926668OtherAETNA
NY155524AIOtherPREFERRED CARE
NYP010101928OtherEXCELLUS BCBS