Provider Demographics
NPI:1871815993
Name:TEAL, PATRICIA KILLGORE (MS)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:KILLGORE
Last Name:TEAL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-1121
Mailing Address - Country:US
Mailing Address - Phone:407-492-8770
Mailing Address - Fax:407-391-9035
Practice Address - Street 1:705 W 1ST ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-1121
Practice Address - Country:US
Practice Address - Phone:407-492-8770
Practice Address - Fax:407-391-9035
Is Sole Proprietor?:No
Enumeration Date:2010-02-16
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001998700Medicaid