Provider Demographics
NPI:1831951748
Name:TELLEZ, MARY ELIZABETH ANNE (MSED)
Entity type:Individual
Prefix:
First Name:MARY ELIZABETH
Middle Name:ANNE
Last Name:TELLEZ
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3282 MIDDLETOWN RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-1041
Mailing Address - Country:US
Mailing Address - Phone:631-687-9234
Mailing Address - Fax:
Practice Address - Street 1:3282 MIDDLETOWN RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-1041
Practice Address - Country:US
Practice Address - Phone:631-687-9234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist