Healthcare Provider Details

I. General information

NPI: 1285554204
Provider Name (Legal Business Name): TEODORO PSYCHIATRIC CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 AIKEN ST
STAUNTON VA
24401-2001
US

IV. Provider business mailing address

1441 AIKEN ST
STAUNTON VA
24401-2001
US

V. Phone/Fax

Practice location:
  • Phone: 206-499-9476
  • Fax: 833-605-4359
Mailing address:
  • Phone: 206-499-9476
  • Fax: 833-605-4359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KELLY TEODORO
Title or Position: OWNER
Credential: NP
Phone: 206-499-9476