Provider Demographics
NPI:1609034875
Name:ANDOLINO, TECILE TRAKESHIA PRINCE (MD)
Entity Type:Individual
Prefix:DR
First Name:TECILE
Middle Name:TRAKESHIA PRINCE
Last Name:ANDOLINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TECILE
Other - Middle Name:TRAKESHIA
Other - Last Name:PRINCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1026
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-1026
Mailing Address - Country:US
Mailing Address - Phone:317-274-1201
Mailing Address - Fax:317-278-9905
Practice Address - Street 1:1701 N SENATE AVE
Practice Address - Street 2:DEPT OF PEDIATRICS
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5306
Practice Address - Country:US
Practice Address - Phone:317-962-8067
Practice Address - Fax:317-962-3796
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01068479208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics