Provider Demographics
NPI:1275096208
Name:NELSON, TERI ELIZABETH
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:ELIZABETH
Last Name:NELSON
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 1:488 E 164TH ST APT 2C
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-6622
Mailing Address - Country:US
Mailing Address - Phone:646-298-7282
Mailing Address - Fax:
Practice Address - Street 1:488 E 164TH ST APT 2C
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-6622
Practice Address - Country:US
Practice Address - Phone:646-298-7282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-08
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician