MEDICARE: NADYA TELT M.D.

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	390200000X	Student in an Organized Health Care Education/Training Program
2	2080P0204X	Pediatric Emergency Medicine (Pediatrics) Physician	ME136321	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285990515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NADYA TELT M.D.

Provider Business Mailing Address
First Line	:	4802 10TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-2916
Country	:	US
Telephone Number	:	718-283-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2502 W SAINT ISABEL ST STE B
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607
Country	:	US
Telephone Number	:	813-874-5707
Fax Number	:

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

Provider Enumeration Date	:	04/11/2012
Last Update Date	:	05/24/2018

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Directions to “ NADYA TELT M.D.” Practice Location

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