Provider Demographics
NPI:1760799597
Name:TESSITORE, BETHANEY NICOLE (AUD)
Entity Type:Individual
Prefix:DR
First Name:BETHANEY
Middle Name:NICOLE
Last Name:TESSITORE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:BETHANEY
Other - Middle Name:
Other - Last Name:TESSITORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:4701 CREEDMOOR RD STE 111
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-4500
Mailing Address - Country:US
Mailing Address - Phone:919-256-2898
Mailing Address - Fax:919-573-0889
Practice Address - Street 1:4701 CREEDMOOR RD STE 111
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-4500
Practice Address - Country:US
Practice Address - Phone:919-256-2898
Practice Address - Fax:919-573-0889
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15570231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist