Serena Teddy, PA-C, MS, RD

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

51359 Issued in CA

Practice address

9918 Katella Ave Ste C
Anaheim, CA 92804-6466

Phone

(714) 625-8320

NPI assigned

Aug 29, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science, Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1188345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1394150400000",
    "number": "1043404379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9918 KATELLA AVE STE C",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928046466",
            "telephone_number": "714-625-8320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9918 KATELLA AVE STE C",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928046466",
            "telephone_number": "714-625-8320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEDDY",
        "first_name": "SERENA",
        "credential": "PA-C, MS, RD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-29",
        "last_updated": "2014-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "CA",
            "license": "00969551",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "51359",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Olivia Taylor
• TDC Pharmaceutical Corporation Inc.
• Jackson Tea, MSN, PMHNP-BC
• Veronica Tea, O.D.
• Ronnie Arianna Bondoc Tecson
• Jeffrey C Teer
• Kelly C Teipe, BS
• Susan Teitelbaum
• Ashley Ann H Tejada, CCC SLP
• Eddyanny Anysha Tejeda

• Physician Assistant in Anaheim, CA
• Providers in Anaheim, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.