Provider Demographics
NPI:1700368982
Name:TEIXEIRA, THALITA
Entity Type:Individual
Prefix:
First Name:THALITA
Middle Name:
Last Name:TEIXEIRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 SUMMIT PL
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06906-1019
Mailing Address - Country:US
Mailing Address - Phone:203-918-1320
Mailing Address - Fax:
Practice Address - Street 1:28 SUMMIT PL
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06906-1019
Practice Address - Country:US
Practice Address - Phone:203-918-1320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY753930163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse