Provider Demographics
NPI:1386314987
Name:BOTANA, TEDDY
Entity type:Individual
Prefix:
First Name:TEDDY
Middle Name:
Last Name:BOTANA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3403 SW 152ND PASS
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-4835
Mailing Address - Country:US
Mailing Address - Phone:786-399-4504
Mailing Address - Fax:
Practice Address - Street 1:3403 SW 152ND PASS
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-4835
Practice Address - Country:US
Practice Address - Phone:786-496-0569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-15
Last Update Date:2025-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist