Provider Demographics
NPI:1467852459
Name:TELESFORD, CHARLLOY (LPN)
Entity Type:Individual
Prefix:
First Name:CHARLLOY
Middle Name:
Last Name:TELESFORD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 CLINTON ST
Mailing Address - Street 2:601
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-4281
Mailing Address - Country:US
Mailing Address - Phone:516-493-9063
Mailing Address - Fax:
Practice Address - Street 1:50 CLINTON ST
Practice Address - Street 2:601
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-4281
Practice Address - Country:US
Practice Address - Phone:516-493-9063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY317002-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse