Provider Demographics
NPI: | 1518970110 |
---|---|
Name: | HERNANDEZ, TERESA ANAYA (MD) |
Entity Type: | Individual |
Prefix: | MRS |
First Name: | TERESA |
Middle Name: | ANAYA |
Last Name: | HERNANDEZ |
Suffix: | |
Gender: | F |
Credentials: | MD |
Other - Prefix: | MRS |
Other - First Name: | TERESA |
Other - Middle Name: | |
Other - Last Name: | ANAYA |
Other - Suffix: | |
Other - Last Name Type: | Professional Name |
Other - Credentials: | MD |
Mailing Address - Street 1: | 1900 E COMMERCIAL BLVD |
Mailing Address - Street 2: | SUITE 202 |
Mailing Address - City: | FT LAUDERDALE |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33308-3737 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 954-351-5840 |
Mailing Address - Fax: | 954-351-7725 |
Practice Address - Street 1: | 1900 E COMMERCIAL BLVD |
Practice Address - Street 2: | SUITE 202 |
Practice Address - City: | FT LAUDERDALE |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33308-3737 |
Practice Address - Country: | US |
Practice Address - Phone: | 954-351-5840 |
Practice Address - Fax: | 954-351-7725 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-08-14 |
Last Update Date: | 2021-06-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | ME75076 | 2080P0006X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2080P0006X | Allopathic & Osteopathic Physicians | Pediatrics | Developmental - Behavioral Pediatrics |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | 257307500 | Medicaid | |
FL | 257307500 | Medicaid | |
FL | G16244 | Medicare UPIN |