Awesome Angels of Change LLC

Primary specialty

Developmental Disabilities Clinic/CenterTaxonomy code 261QD1600X

Legal business name

AWESOME ANGELS OF CHANGE LLC

Practice address

3909 Sandhill Crane Dr
Lakeland, FL 33811-1862

Phone

(863) 617-5840

NPI assigned

Jan 17, 2019

Last updated

Jan 17, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Shacoya MontgomeryNPI 1316416381

Title

Ceo

Phone

(863) 617-5840

Specialties & licenses 1

Addresses

Other names 1

• AAC Former legal business name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Shacoya Montgomery

  • Developmental Disabilities Clinic/Center
  • Lakeland, FL
  • NPI 1316416381
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1547683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1547683200000",
    "number": "1497229926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3909 SANDHILL CRANE DR",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338111862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3909 SANDHILL CRANE DR",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338111862",
            "telephone_number": "863-617-5840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AWESOME ANGELS OF CHANGE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-17",
        "last_updated": "2019-01-17",
        "status": "A",
        "authorized_official_last_name": "MONTGOMERY",
        "authorized_official_first_name": "SHACOYA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "863-617-5840"
    },
    "taxonomies": [
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AAC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Karina Ivon Auza de Ryvnine, PA-C
• Rhonda Lynn Avery, RD LD N
• Mariano Avila
• Adriene Lynn Avripas, NP
• Musa Haseeb Awan, MD
• Jordan Axe, D.C.
• Lilliam Enid Ayala Garcia, MD
• Jiann M. Ayala
• Ayan Wellness
• Melantha Aye, MD

• Developmental Disabilities Clinic/Center in Lakeland, FL
• Providers in Lakeland, FL by specialty
• Developmental Disabilities Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.