MEDICARE: TERESA NDIAYE

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	3747A0650X	Attendant Care Provider	58436	FL

General Provider Information

NPI Number	:	1760831556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA NDIAYE

Provider Business Mailing Address
First Line	:	4523 JADE DR E
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-4714
Country	:	US
Telephone Number	:	904-240-8467
Fax Number	:

Provider Business Practice Location Address
First Line	:	4523 JADE DR E
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-4714
Country	:	US
Telephone Number	:	904-240-8467
Fax Number	:

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

Provider Enumeration Date	:	06/13/2016
Last Update Date	:	06/13/2016

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Directions to “ TERESA NDIAYE ” Practice Location

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