MEDICARE: THERESA ADADZEWA FYNN MD

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	174400000X	Specialist	ME109189	FL
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	ME109189	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	:	1669639266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA ADADZEWA FYNN MD

Provider Business Mailing Address
First Line	:	3004 17TH ST
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34769-6011
Country	:	US
Telephone Number	:	407-593-2910
Fax Number	:	407-593-2913

Provider Business Practice Location Address
First Line	:	3004 17TH ST
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34769-6011
Country	:	US
Telephone Number	:	407-593-2910
Fax Number	:	407-593-2913

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

Provider Enumeration Date	:	05/21/2008
Last Update Date	:	02/05/2014

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