MEDICARE: TED ROBERT VANA DO

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	2083P0500X	Preventive Medicine/Occupational Environmental Medicine Physician	OS-009175-L	PA
2	2083P0500X	Preventive Medicine/Occupational Environmental Medicine Physician	OS 10551	FL
3	207Q00000X	Family Medicine Physician	OS10551	FL

General Provider Information

NPI Number	:	1396974614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TED ROBERT VANA DO

Provider Business Mailing Address
First Line	:	14750 NW 77TH CT STE 100
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-1507
Country	:	US
Telephone Number	:	786-758-3165
Fax Number	:

Provider Business Practice Location Address
First Line	:	4450 E FLETCHER AVE STE D
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33613-4907
Country	:	US
Telephone Number	:	813-632-8861
Fax Number	:	813-977-4907

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

Provider Enumeration Date	:	07/08/2009
Last Update Date	:	03/28/2025

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