Provider Demographics
NPI:1710361258
Name:TEODORO, SIMONE DE MAAR (NP)
Entity Type:Individual
Prefix:
First Name:SIMONE
Middle Name:DE MAAR
Last Name:TEODORO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SIMONE
Other - Middle Name:DE MAAR
Other - Last Name:TEODORO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:240 E 38TH ST FL 14
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-2708
Mailing Address - Country:US
Mailing Address - Phone:646-501-7889
Mailing Address - Fax:
Practice Address - Street 1:240 E 38TH ST FL 14
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-2708
Practice Address - Country:US
Practice Address - Phone:646-501-7889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-15
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY339907363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily