MEDICARE: THERESA MCCREADY P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	010412-1	NY
2	363A00000X	Physician Assistant	9104660	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003883943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA MCCREADY P.A.

Provider Business Mailing Address
First Line	:	10339 CREATION CT
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34654-3661
Country	:	US
Telephone Number	:	631-786-9123
Fax Number	:

Provider Business Practice Location Address
First Line	:	3231 MCMULLEN BOOTH RD
Second Line	:
City	:	SAFETY HARBOR
State	:	FL
Zip	:	34695-6607
Country	:	US
Telephone Number	:	727-507-3600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	12/08/2015

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