Provider Demographics
NPI:1669200127
Name:TELFORT, WHITNEY LASHONDA
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:LASHONDA
Last Name:TELFORT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 WHISPERING CYPRESS LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32824-5279
Mailing Address - Country:US
Mailing Address - Phone:904-422-2583
Mailing Address - Fax:
Practice Address - Street 1:611 WHISPERING CYPRESS LN
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32824-5279
Practice Address - Country:US
Practice Address - Phone:904-422-2583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-24
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11034275363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health