Provider Demographics
NPI:1578552303
Name:SANTOS, TERESA D (MD)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:D
Last Name:SANTOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1636 S OCEAN DR
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-3244
Mailing Address - Country:US
Mailing Address - Phone:954-614-5520
Mailing Address - Fax:
Practice Address - Street 1:9611 W BROWARD BLVD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2334
Practice Address - Country:US
Practice Address - Phone:954-424-7000
Practice Address - Fax:954-424-6003
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56353208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373798500Medicaid