Healthcare Provider Details

I. General information

NPI: 1003900622
Provider Name (Legal Business Name): FELICIA TENEDIOS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FELICIA TENEDIOS MD

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 SOUTH AVE STE 204
STATEN ISLAND NY
10314-3420
US

IV. Provider business mailing address

1200 SOUTH AVE STE 204
STATEN ISLAND NY
10314-3420
US

V. Phone/Fax

Practice location:
  • Phone: 718-447-0055
  • Fax: 718-876-5212
Mailing address:
  • Phone: 718-447-0055
  • Fax: 718-876-5212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number223500
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: