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General NPI Number Information
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NPI Number | 1336197979
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Entity Type | Individual
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Provider Name | TERESA RIBADENYRA PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/05/2006
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Last Update Date | 01/13/2010
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Provider Practice Location Address
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Address Line | 710 STOCKBRIDGE RD
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City | LEE
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State | MA
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Zip | 01238-9316
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Country | US
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Telephone | 413-243-0122
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Fax | 413-243-2251
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Provider Business Mailing Address
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Address Line | 1556 ROUTE 203
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City | CHATHAM
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State | NY
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Zip | 12037-1708
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 177485
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License Number State | MA
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