Individual provider · NPI-1

Dr. Marie Angeline Antonyrajah, M.D.

Pediatrics · Daytona Beach, FL

NPI number1497043046

StatusActive

Last updated in NPPESMar 13, 2025

Details

NPI: 1497043046
Entity type: Individual (NPI-1)
Name: Dr. Marie Angeline Antonyrajah
Credential: M.D.
Sex: Female
Sole proprietor: No
Enumeration date: Jul 18, 2011
Certification date: Mar 11, 2025
Last updated: Mar 13, 2025

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
208000000X	Pediatrics	ME120640	FL	Yes
207PP0204X	Emergency Medicine, Pediatric Emergency Medicine	ME120640	FL
208M00000X	Hospitalist	ME120640	FL
390200000X	Student in an Organized Health Care Education/Training Program	–	–

Practice location

303 N Clyde Blvd
Daytona Beach, FL 32114

Phone 386-425-4000

Mailing address

303 N Clyde Blvd
Daytona Beach, FL 32114-0532

Phone 904-697-5062 · Fax 386-425-4000

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