Provider Demographics
NPI:1659410264
Name:NEIRA, TERESA (MD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:
Last Name:NEIRA
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:CALLE AVENUE 82
Mailing Address - Street 2:#861, APARTMENT 303
Mailing Address - City:BOGOTA,
Mailing Address - State:SOUTH AMERICA
Mailing Address - Zip Code:00000
Mailing Address - Country:CO
Mailing Address - Phone:01157311-506-7504
Mailing Address - Fax:
Practice Address - Street 1:3650 MANSELL RD
Practice Address - Street 2:SUITE 310
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-3012
Practice Address - Country:US
Practice Address - Phone:800-562-8663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY165868-12084P0800X
FLME849392084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA97214Medicare UPIN