Provider Demographics
NPI:1134574478
Name:TEJADA ROMERO, NELLY (MD)
Entity type:Individual
Prefix:
First Name:NELLY
Middle Name:
Last Name:TEJADA ROMERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NELLY
Other - Middle Name:ADRIANA
Other - Last Name:TEJADA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1950 CIRCLE OF HOPE DR
Mailing Address - Street 2:HUNSTMAN CANCER HOSPITAL RM N3100
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84112-5500
Mailing Address - Country:US
Mailing Address - Phone:801-587-4563
Mailing Address - Fax:
Practice Address - Street 1:1950 CIRCLE OF HOPE DR
Practice Address - Street 2:HUNSTMAN CANCER HOSPITAL RM N3100
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84112-5500
Practice Address - Country:US
Practice Address - Phone:801-587-4563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-24
Last Update Date:2016-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT039567207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology