MEDICARE: DR. TERESA SPANO ND, CNS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133N00000X	Nutritionist	ND8843	FL
2	175F00000X	Naturopath	500	CT

General Provider Information

NPI Number	:	1063844678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERESA SPANO ND, CNS

Provider Business Mailing Address
First Line	:	18 SCHOOL ST
Second Line	:
City	:	GLASTONBURY
State	:	CT
Zip	:	06033-2241
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1570 COLONIAL BLVD STE A
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-1031
Country	:	US
Telephone Number	:	239-766-7311
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2013
Last Update Date	:	02/16/2024

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