Provider Demographics
NPI:1477155786
Name:TEELE, VICTORIA DIANNE
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:DIANNE
Last Name:TEELE
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 1:2751 PARK LN NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-2717
Mailing Address - Country:US
Mailing Address - Phone:321-806-5024
Mailing Address - Fax:
Practice Address - Street 1:1600 SARNO RD STE 3
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-4992
Practice Address - Country:US
Practice Address - Phone:321-622-6290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-11
Last Update Date:2022-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other