Provider Demographics
NPI:1134851447
Name:TENG, EDITH MELODY (PA-C)
Entity type:Individual
Prefix:
First Name:EDITH
Middle Name:MELODY
Last Name:TENG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2219 TOWN CENTER DR SE APT 385
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-4040
Mailing Address - Country:US
Mailing Address - Phone:512-909-8132
Mailing Address - Fax:
Practice Address - Street 1:490 GARTINA HWY
Practice Address - Street 2:
Practice Address - City:HOONAH
Practice Address - State:AK
Practice Address - Zip Code:99829
Practice Address - Country:US
Practice Address - Phone:907-945-2735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1196014363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant