Provider Demographics
NPI:1912423575
Name:REDFORD-BANTON, TERESA
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:REDFORD-BANTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 299
Mailing Address - Street 2:
Mailing Address - City:AMELIA COURT HOUSE
Mailing Address - State:VA
Mailing Address - Zip Code:23002-0299
Mailing Address - Country:US
Mailing Address - Phone:804-561-4143
Mailing Address - Fax:
Practice Address - Street 1:22011 GENITO RD
Practice Address - Street 2:
Practice Address - City:AMELIA COURT HOUSE
Practice Address - State:VA
Practice Address - Zip Code:23002-5309
Practice Address - Country:US
Practice Address - Phone:804-561-4143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver