Healthcare Provider Details

I. General information

NPI: 1932388709
Provider Name (Legal Business Name): ROBERTA GIUDICE-TELLER DPM PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 06/21/2010
Certification Date:
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:
Mailing address:
  • Phone: 352-372-3474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPO 0001675
License Number StateFL

VIII. Authorized Official

Name: DR. ROBERTA GIUDICE-TELLER
Title or Position: PHYSICIAN
Credential: DPM
Phone: 352-372-3474