Edna Lillian Tello, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

ME80694 Issued in FL

Practice address

12621 NW 8TH CT
Coral Springs, FL 33071-4425

Phone

(954) 632-2791

Fax

(954) 796-6584

NPI assigned

Aug 9, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Athletamd LLC

  • Pediatrics Physician
  • Coral Springs, FL
  • NPI 1861078032
  NPD (past) Authorized official
• Personalized Pediatrics LLC

  • Pediatrics Physician
  • Coral Springs, FL
  • NPI 1215329313
  NPD (past) Authorized official

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1528078508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1440 CORAL RIDGE DR",
            "address_2": "#121",
            "city": "CORAL SPRINGS",
            "state": "FL",
            "postal_code": "330715433",
            "telephone_number": "954-632-2791",
            "fax_number": "954-796-6584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12621 NW 8TH CT",
            "city": "CORAL SPRINGS",
            "state": "FL",
            "postal_code": "330714425",
            "telephone_number": "954-632-2791",
            "fax_number": "954-796-6584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TELLO",
        "first_name": "EDNA",
        "middle_name": "LILLIAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME80694",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2606259",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shayla Elizabeth Taylor, PHARMD
• TDC Lakeview, LLC
• TDC Parkland
• Televisitmd Inc
• Damaris Tello, MSPT
• Jennie Telus
• Edine Johanne Telusma, ARNP
• Jean Junior Telusma, M.D.
• Allen J. Teman, M. D.
• Tendercare Home Help Providers LLC

• Pediatrics Physician in Coral Springs, FL
• Providers in Coral Springs, FL by specialty
• Pediatrics Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.