Athletamd LLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

ATHLETAMD LLC

Practice address

12621 NW 8TH Court
Coral Springs, FL 33071

Phone

(954) 543-1760

Fax

(954) 752-7845

NPI assigned

Mar 19, 2021

Organization subpart

No

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

Authorized official

Name

Mrs. Edna Lillian Tello, MDNPI 1528078508

Title

MD / Owner

Phone

(954) 632-2791

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Edna Lillian Tello, M.D.

  • Pediatrics Physician
  • Coral Springs, FL
  • NPI 1528078508
  NPD (past) Authorized official

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

{
    "created_epoch": "1616112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616112000000",
    "number": "1861078032",
    "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": "33071",
            "telephone_number": "954-543-1760",
            "fax_number": "954-752-7845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12621 NW 8TH COURT",
            "city": "CORAL SPRINGS",
            "state": "FL",
            "postal_code": "33071",
            "telephone_number": "954-543-1760",
            "fax_number": "954-752-7845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATHLETAMD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-19",
        "last_updated": "2021-03-19",
        "certification_date": "2021-02-17",
        "status": "A",
        "authorized_official_last_name": "TELLO",
        "authorized_official_first_name": "EDNA",
        "authorized_official_middle_name": "LILLIAN",
        "authorized_official_title_or_position": "MD / OWNER",
        "authorized_official_telephone_number": "954-632-2791",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• 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 Mar 19, 2021; 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.