Individual
DR. TEODORA ANN SCHELLATO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O
Contact information
Practice address
7604 CENTRAL AVE, SUITE 104, PHILADELPHIA, PA 19111-2433
(215) 745-4130
Mailing address
7604 CENTRAL AVE, SUITE 104, PHILADELPHIA, PA 19111-2433
(215) 745-4130
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
OS013079
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1023982290001
—
PA
01
—
168067
MEDICARE UNSPECIFIED
PA
01
—
2109882
PA BLUE SHIELD
PA
01
—
3724847000
INDEPENDENCE BLUE CROSS
PA
Enumeration date
05/10/2007
Last updated
01/16/2011
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