MEDICARE: ANDREA TELESCA ATC

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	2255A2300X	Athletic Trainer	67002593	NY

General Provider Information

NPI Number	:	1174959324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA TELESCA ATC

Provider Business Mailing Address
First Line	:	1 SAXON DR
Second Line	:
City	:	ALFRED
State	:	NY
Zip	:	14802-1205
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 SAXON DR
Second Line	:
City	:	ALFRED
State	:	NY
Zip	:	14802-1205
Country	:	US
Telephone Number	:	607-871-2712
Fax Number	:

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

Provider Enumeration Date	:	09/19/2013
Last Update Date	:	09/19/2013

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