Individual
MICHELLE P TELLADO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1717 S ORANGE AVE, ORLANDO, FL 32806-2944
(321) 452-1061
Mailing address
10140 CENTURION PKWY N, JACKSONVILLE, FL 32256-0532
(904) 697-4100
(904) 697-5102
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
ME127519
FL
208M00000X
Hospitalist Physician
ME127519
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
018374500
—
FL
Enumeration date
05/09/2013
Last updated
04/26/2019
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