Healthcare Provider Details

I. General information

NPI: 1710901145
Provider Name (Legal Business Name): ROBERTA GIUDICE-TELLER DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 03/06/2020
Certification Date: 03/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 NW 6TH ST
GAINESVILLE FL
32601-4249
US

IV. Provider business mailing address

1010 NW 6TH ST
GAINESVILLE FL
32601-4249
US

V. Phone/Fax

Practice location:
  • Phone: 352-372-3474
  • Fax: 352-372-1252
Mailing address:
  • Phone: 352-372-3474
  • Fax: 352-372-1252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPO 0001675
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO1675
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: