Healthcare Provider Details

I. General information

NPI: 1356474589
Provider Name (Legal Business Name): STEPHEN F TEODORO AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13934 NORTH 59TH AVENUE SUITE #120
GLENDALE AZ
85306
US

IV. Provider business mailing address

13934 N. 59TH AVENUE SUITE #120
GLENDALE AZ
85306
US

V. Phone/Fax

Practice location:
  • Phone: 602-866-0147
  • Fax: 602-547-9644
Mailing address:
  • Phone: 602-866-0147
  • Fax: 602-547-9644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberDA529
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: