Provider Demographics
NPI:1316425762
Name:TEDESCO, SOFIA (DC)
Entity type:Individual
Prefix:
First Name:SOFIA
Middle Name:
Last Name:TEDESCO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 MAIN MEWS
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-6549
Mailing Address - Country:US
Mailing Address - Phone:301-801-8461
Mailing Address - Fax:
Practice Address - Street 1:14804 PHYSICIANS LN STE 222
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3947
Practice Address - Country:US
Practice Address - Phone:301-424-0220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-29
Last Update Date:2018-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS03982111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner