Provider Demographics
NPI:1699739136
Name:NELSON, TERESITA YAP (MD)
Entity type:Individual
Prefix:
First Name:TERESITA
Middle Name:YAP
Last Name:NELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 602478
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2478
Mailing Address - Country:US
Mailing Address - Phone:704-541-8788
Mailing Address - Fax:704-541-1069
Practice Address - Street 1:12311 COPPER WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-3642
Practice Address - Country:US
Practice Address - Phone:704-541-8788
Practice Address - Fax:704-541-1069
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0094005942084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8962092Medicaid
NC1699739136Medicaid
NC2201339Medicare PIN
NC8962092Medicaid
NC2201339AMedicare PIN