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NPI Code Detail

MEDICARE: DONICA TEDROS

MEDICARE: DONICA TEDROS
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
12255A2300XAthletic Trainer3290TN

General Provider Information

NPI Number : 1508677451
Entity Type Code : Individual
Provider Name (Legal Business Name) : DONICA TEDROS
Provider Business Mailing Address
First Line : 13029 RHAPSODY LN
Second Line :
City : SILVER SPRING
State : MD
Zip : 20904-6864
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1115 E GETWELL LOOP
Second Line :
City : MEMPHIS
State : TN
Zip : 38152-4210
Country : US
Telephone Number : 901-678-2247
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2025
Last Update Date : 01/18/2025

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Directions to “ DONICA TEDROS ” Practice Location

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