Provider Demographics
NPI:1609122720
Name:GAUGH, TELESFORA (TEACHER)
Entity Type:Individual
Prefix:
First Name:TELESFORA
Middle Name:
Last Name:GAUGH
Suffix:
Gender:F
Credentials:TEACHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 MORICHES AVE
Mailing Address - Street 2:
Mailing Address - City:MASTIC
Mailing Address - State:NY
Mailing Address - Zip Code:11950-3835
Mailing Address - Country:US
Mailing Address - Phone:646-338-7616
Mailing Address - Fax:
Practice Address - Street 1:24 MORICHES AVE
Practice Address - Street 2:
Practice Address - City:MASTIC
Practice Address - State:NY
Practice Address - Zip Code:11950-3835
Practice Address - Country:US
Practice Address - Phone:646-338-7616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY651394174400000X
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist