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
StateLicense IDTaxonomies
FLME750762080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257307500Medicaid
FL257307500Medicaid
FLG16244Medicare UPIN