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General NPI Number Information
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NPI Number | 1467601401
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Entity Type | Individual
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Provider Name | LARISSA A. TEDESCO PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/15/2008
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 222 WESTCHESTER AVE SUITE 102
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City | WHITE PLAINS
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State | NY
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Zip | 10604-2906
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Country | US
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Telephone | 914-946-1010
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Fax | 914-946-1025
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Provider Business Mailing Address
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Address Line | 2408 WHITNEY AVE
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City | HAMDEN
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State | CT
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Zip | 06518-3209
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Country | US
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Telephone | 203-626-0160
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Fax | 203-294-6734
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 010822-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 1688
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1688
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License Number State | CT
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