Provider Demographics
NPI:1356474589
Name:TEODORO, STEPHEN F (AUD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:F
Last Name:TEODORO
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13934 N. 59TH AVENUE
Mailing Address - Street 2:SUITE #120
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306
Mailing Address - Country:US
Mailing Address - Phone:602-866-0147
Mailing Address - Fax:602-547-9644
Practice Address - Street 1:13934 NORTH 59TH AVENUE
Practice Address - Street 2:SUITE #120
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306
Practice Address - Country:US
Practice Address - Phone:602-866-0147
Practice Address - Fax:602-547-9644
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA529231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ28064Medicare ID - Type Unspecified
AZS16329Medicare UPIN