| Doctor Name: | DR. ANGELIQUE RENAE POLIDORO |
| NPI Number: | 1396945317 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | D.O. |
| License Number: | 2010-01605 |
| Business Practice Address: | 5553 N Croatan Hwy Southern Shores, NC - 279494117 |
| Business Phone Number: | 2524495780 |
| Business Fax Number: | 2524495799 |
| Mailing Address: | 5553 N Croatan Hwy, SOUTHERN SHORES |
| State: | NC |
| Postal Code: | 279494117 |
| Phone Number: | 2524495780 |
| Fax Number: | 2524495799 |
| NPI Enumeration Date: | 07/18/2007 |
| NPI Last Update Date: | 01/23/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 2010-01605 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NC |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |