Provider Demographics
NPI:1841537693
Name:TEDESCO, TDD JOSEPH (RN)
Entity type:Individual
Prefix:
First Name:TDD
Middle Name:JOSEPH
Last Name:TEDESCO
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4515 CARLYLE CT
Mailing Address - Street 2:APT 3312
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95054-3915
Mailing Address - Country:US
Mailing Address - Phone:904-327-9638
Mailing Address - Fax:
Practice Address - Street 1:4515 CARLYLE CT
Practice Address - Street 2:APT 3312
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95054-3915
Practice Address - Country:US
Practice Address - Phone:904-327-9638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA810385163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health