Healthcare Provider Details

I. General information

NPI: 1427261544
Provider Name (Legal Business Name): TERESA A FAXAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 W SAMPLE RD
CORAL SPRINGS FL
33065-3936
US

IV. Provider business mailing address

10000 W SAMPLE RD
CORAL SPRINGS FL
33065-3936
US

V. Phone/Fax

Practice location:
  • Phone: 954-346-8800
  • Fax:
Mailing address:
  • Phone: 954-346-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME60817
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: