Provider Demographics
NPI:1902964323
Name:TEODORESCU, CRISTIANA FLORIANA (MD)
Entity Type:Individual
Prefix:
First Name:CRISTIANA
Middle Name:FLORIANA
Last Name:TEODORESCU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CRISTIANA
Other - Middle Name:FLORIANA
Other - Last Name:TOHANEANU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 503900
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-3900
Mailing Address - Country:US
Mailing Address - Phone:314-577-5609
Mailing Address - Fax:314-268-4028
Practice Address - Street 1:1465 S GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-1003
Practice Address - Country:US
Practice Address - Phone:314-577-5609
Practice Address - Fax:314-268-4028
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20030110642084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207274606Medicaid