MEDICARE: DALTON TEAGUE

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	106S00000X	Behavior Technician	RBT-26-516165	FL

General Provider Information

NPI Number	:	1679436471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DALTON TEAGUE

Provider Business Mailing Address
First Line	:	305 S OCEAN GRANDE DR
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-4594
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 LAND GRANT ST UNIT 1
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32092-2270
Country	:	US
Telephone Number	:	904-886-3228
Fax Number	:

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

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	05/06/2026

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Directions to “ DALTON TEAGUE ” Practice Location

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