Provider Demographics
NPI:1710032248
Name:TEITELMAN, AMY EILEEN-HENDRICKS (BS,)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:EILEEN-HENDRICKS
Last Name:TEITELMAN
Suffix:
Gender:F
Credentials:BS,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 CUSTER RD
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-5623
Mailing Address - Country:US
Mailing Address - Phone:972-490-9055
Mailing Address - Fax:972-490-9058
Practice Address - Street 1:320 CUSTER RD
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-5623
Practice Address - Country:US
Practice Address - Phone:972-490-9055
Practice Address - Fax:972-490-9058
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41340171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator