MEDICARE: MRS. THAO T. QUEVEDO PA-C

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	PA01763	TX

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
2	8N4446	OTHER	TX	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518967504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. THAO T. QUEVEDO PA-C

Provider Business Mailing Address
First Line	:	5702 LAVON DR
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75040-3126
Country	:	US
Telephone Number	:	866-389-2727
Fax Number	:	972-495-0327

Provider Business Practice Location Address
First Line	:	5702 LAVON DR
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75040-3126
Country	:	US
Telephone Number	:	972-495-5595
Fax Number	:	972-675-5806

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

Provider Enumeration Date	:	07/30/2005
Last Update Date	:	01/06/2026

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